An Economic Evaluation of Zambia’s Human Papilloma Virus (HPV) Vaccination Programme

Abstract

This thesis presents an integrating narrative of five interrelated studies evaluating the cost-effectiveness of Zambia’s national Human Papillomavirus (HPV) vaccination programme. It addresses a critical evidence gap in locally contextualised economic evaluations to inform sustainable policy and immunisation strategies in low- and middle-income countries. The research assessed costs and cost-effectiveness of three HPV vaccine delivery platforms—school-based, community outreach, and health facility—compared to cervical cancer screening alone, with additional analysis for HIV-positive subpopulations. Using a Markov model informed by primary costing data, a systematic review, and programmatic insights, the study found that school-based delivery was the most cost-effective (ICER: $65 per DALY averted), followed by the combined approach (ICER: $263). Community outreach and health facility models were significantly less cost-effective. The research further explored how COVID-19 disrupted immunisation financing and delivery, which also affected HPV vaccine delivery at the time of the study. This represents an important contextual consideration in understanding programme performance, costs, and sustainability challenges. The study underscores the need for locally driven health technology assessments (HTAs) and context-specific data to guide vaccine policy decisions. Its findings are intended to support Zambia’s Expanded Programme on Immunisation (EPI), ZITAG, and other stakeholders in optimising delivery strategies as the country transitions from donor support.