Economic Cost Analysis of Single-Dose HPV Vaccination Services for Out-of-School (OOS) Girls in Indonesia: A Microcosting Study.

Abstract

Cervical cancer remains a major public health challenge in Indonesia, with Human Papillomavirus (HPV) infection responsible for nearly all cases. To address this burden, the government has integrated HPV vaccination into the national School Children Immunization Month (BIAS). However, out-of-school (OOS) girls remain difficult to reach because they are not covered by the school-based vaccination platform. This study aimed to estimate the cost required for delivering a one-dose HPV vaccination program to OOS girls conducted in Bekasi City, Bandar Lampung City, and Bangka District by using a micro-costing approach. The analysis systematically categorized expenditures into outreach efforts, such as community mobilization and identification of girls, and delivery components including logistics, storage, and administration. The results show that the cost per vaccinated OOS girl ranged from US$ 22.77 to 38.55, varying by implementation context, with outreach activities, and transportation and vaccine delivery supplies identified as the main cost drivers. as the main cost drivers. This study also estimates the scale-up costs for HPV vaccination targeting OOS girls, revealing a total national delivery cost of US$ 644,215.23 per year. The result shows that 81.50% of the total national delivery cost is allocated to vaccine delivery components, while 18.50% is attributed to outreach activities required to identify and engage the target population. These findings provide important cost estimates to inform budgeting and planning to support more equitable HPV vaccine delivery to out-of-school girls in Indonesia. These findings suggest that HPV vaccination for OOS girls program is potentially economically feasible. Strengthening coordination across sectors and adapting implementation to local contexts will be key to ensuring both cost-efficiency and program sustainability.