Table 3.

Assumptions made for delivery cost analysis of vaccines.

Vaccine	Prevnar®	Rotateq®	Gardasil®
Target population	376,202 infants 0-1 years in 2010	394,473 infants 0-1 years in 2012	91,317 girls in P6 in school (9-18 years) and 3,066 girls who were out of school and 12 years old
Number of doses per child	3	3	3
Price of Vaccine	Financial: $0.20 per dose co-financing Economic: $3.50/dose	Financial: $0.20 per dose co-financing Economic: $5.00/dose	Vaccines donated during 1st three years but MoH paid for syringes, receiving, clearance and storage; assumed $5.00/dose for economic costs (not inclusive of costs of receiving and storage of the vaccine)
Type of Vaccine, presentation and cold chain volume	Prevnar® in prefilled syringe for intramuscular injection, 55.9 cc	RotaTeq® in single dose applicator for oral administration, 46.3 cc	Gardasil® in single dose vial with separate syringe for intramuscular injection, 15 cc.
Administrative Vaccine Coverage	First dose coverage was reported to be 80%, then dropout of approximately 1% occurred for each of the 2nd and 3rd doses	Assume 80% coverage for 1st dose, with 1% and 0.5% dropout rates for 2nd and 3rd doses	First dose was reported to be 97% with dropout of 2% occurred for each of the 2nd and 3rd doses
Country Co-financing for Gavi	Rwanda began co-financing Prevnar®a in 2010 at $0.20/dose	Co-financing will begin in 2012 at $0.20/dose	NA
Introduction Costs (Micro-planning, training, Soc.Mob./IEC)	Assumed to last five years	Assumed to last five years	Assumed to last five years
Cold Chain	bHalf of the cold chain equipment purchased for Prevnar was later used for HPV vaccines	New refrigerators were purchased for Rotateq®.for the district (87) and health center levels (131).	bHalf of the cold chain equipment purchased for Prevnar was later used for HPV vaccines
Service delivery	Six minutesc vaccinator time per vaccination in clinic	Six minutes vaccinator time per vaccination in clinic	Six minutesc vaccinator time per vaccination in clinic Health worker outreach allowances (5000 Rwanda francs or approximately $8) for visiting each school; 2,510 schools were visited by teams of 2 health workers
Supervision	Supervisory trips three times a year: Travel allowance, per diem, fuel; staff salaries; 20% allocated to PCV	Supervisory trips three times a year: Travel allowance, per diem, fuel; staff salaries; 20% allocated to RV	Supervision takes place during HPV vaccination and included in cost of service delivery
Monitoring and evaluation	Printing of new vaccination cards and tally sheets, post-introduction evaluation, surveillance	Printing new vaccination cards, post-introduction evaluation, surveillance	Printing new vaccination cards, post-introduction evaluation, surveillance
Waste management	Incineration and Burial of prefilled syringes;	Incineration and Burial; Disposal of plastic dosing tubes	Incineration and Burial

^aRwanda obtained Prevnar as a donation from Wyeth, the manufacturer, in 2009 and the government only paid for transport, receiving and clearance; it began getting the vaccine through Gavi in 2010 and paying the co-financing fees.

^bSince 50% of the cold chain costs for the Prevnar introduction were actually attributed to Gardasil introduction, the costs of introducing Prevnar was slightly underestimated.

^cBased on program manager estimates.