Table 1.

Summary of publications reviewed.

Author & Year	Location	Gavi-supported	Study design	Target age cohort	Sample size	HPV vaccination outcomes assessed	Strategies Utilized	Main results of costs and effectiveness
I.Program Cost Evaluations
Alonso 2019	Mozambique	✓	Demonstration program with retrospective micro costing	10-year-old girls	2 doses: 2,791 FIG3 doses: 2,276 FIG	•Cost per FIG •HPV vaccine program cost	•School-based delivery	•US$9.99 per FIG under the two-dose schedule •$17.95 per FIG under the three-dose schedule
Hidle 2018	Zimbabwe	✓	Demonstration program with retrospective cost analysis	10-year-old girls	5,724 FIG	•Cost per FIG •HPV vaccine program cost	•School-based delivery •Facility-based delivery •Outreach sites	•Lower mean service delivery cost in schools with more girl vaccinated in each vaccination cycle. •Economic cost of US17.39 per FIG using school-based delivery.
Levin 2013	PeruUgandaVietnam	✓	Demonstration Program with retrospective micro costing	Adolescent girls	17, 268 FIG	•Cost per FIG •Cost of different HPV vaccination strategies •Projected financial costs of national scale-up	•Peru: School-based delivery •Uganda: School-based and integrated outreach delivery •Vietnam: School-based and health-center-based delivery	•The cost per vaccine dose was lowest when delivery was integrated into existing health services (US$ 1.44 per dose in Uganda) •The maximum number of doses administered per year was 26,798 doses resulting in 8,895 FIG using the school-based strategy in Peru
Quentin 2012	Tanzania	--Sponsor-subsidized acquisition cost	Demonstration program with retrospective top-down cost analysis from project’s perspective	10-to12-year-old girls (class 4 and class 6)	4,211 FIG	•Cost per FIG •HPV vaccination project cost •Projected scale-up costs for a regional program	•School-based delivery	•costs of class-based vaccination were less •because of more eligible girls being identified and higher vaccine uptake •Lower costs in urban areas compared to rural areas. •Incremental financial cost to scale up to 50,290 primary school girls estimated at US$276,00 •Economic cost of US$9.76 per FIG excluding vaccine cost
Soi 2019	Mozambique	✓	Demonstration program with retrospective micro costing	10-year-old girls	Target population sizeYear 1: 8,556Year 2: 9,135	•Cost per FIG •Total program costs •Projected costs for national scale-up	•School-based delivery	•Higher implementation costs in year one compared to year two •Cost per FIG: $72 in year one, $38 in year two, and $54 for entire project period
II.Cost Effectiveness Analyses
Blakely 2014	New Zealand	–	Markov modelHealth system’s perspective	12-year-ollds	National sample: 58,582	•Health gains •Net costs •Cost effectiveness of ongoing national HPV vaccination program	•Vaccination at school •Vaccination in primary care practices	•Cost-effectiveness of current program: NZ$18,800/QALY gained •ICER of $34,700/QALY for school-only program compared to school + PCP •Net cost for current program: NZ$4.65 million for 58,582 12-year-old •A mandatory vaccination law for HPV is not cost-effective.
Wilson 2020	Texas, USA	–	Markov modelPayer’s perspective	Uninsured and low-income adults	1,036 received HPV vaccines	•Cost effectiveness of comprehensive adult vaccination program; HPV vaccines included	•Local health department working with community organizations	•At a cost-effective threshold of $100,00, HPV vaccination was cost effective with an ICER of $79,022/LYS •Program ICER: $67,940/LYS •A community immunization program is a cost-effective investment for uninsured, low income, high-risk adults
III.Novel Interventions
Coley 2018	New York, USA	–	Randomized controlled trial	11-to-13-year olds	Intervention: 81,558Control: 80,894	•Vaccine series initiation •Series continuation •Cost analysis •Population health effects	•Reminder letters mailed by the state’s health department	•Intervention increased vaccine initiation by 2.2% for 1st dose, 1.4% for 2nd dose, 0.01% for 3rd dose. •The intervention cost $30.95 for each adolescent who initiated the HPV vaccine series.
Fiks 2013	Philadelphia, USA	–	Randomized controlled trial; cluster and patient-level randomization	11-to-17-year-old girls	Total: 22,486CDS: 5,557FFI: 5680CDS + FFI: 5,561No intervention: 5,68811 clinics	•HPV vaccine series rates •Time to HPV vaccine receipt •Incremental cost effectiveness of interventions	•FFI •CDS •Combined (FFI + CDS)	•CDS was most effective for initiating the HPV vaccination series, FFI promoted completion, and CDS + FFI most effectively promoted series receipt. •For the 3 doses of HPV vaccines, the combined intervention increased vaccination rates from 16% to 25%, from 65% to 73%, and from 63% to 76%, respectively, compared with no intervention. •Low incremental cost for the more effective intervention versus no intervention: $6 for CDS for HPV#1, $10 and $6 for FFI for doses 2 and 3, respectively.
Kempe 2012	Colorado, USA	–	Multi-method study: HPV vaccine demonstration project for girls only, and randomized controlled trial for boys	Sixth graders attending public schools; girls only for HPV vaccines	Total: 529Girls: 265	•Proportion that received the first dose of HPV vaccine •Cost per recalled child immunized	•Immunization recall at school-based health centers	•59% (149/253) of girls received the first HPV vaccine dose •Cost ranged from $1.12 to $6.87 per recalled child immunized
Lefevere 2016	Flanders, Belgium	–	Retrospective cohort study analyzing claims data	12-to-18-year-old girls	Total: 6415Intervention: 850	•HPV vaccine series initiation	•Personal information campaign (PIC) only •Combined PIC plus financial incentives (partial reimbursement)	•PIC significantly increased vaccination initiation, with older girls responding faster. •One year after the campaign the difference in percentage points for HPV vaccination initiation between intervention and control groups varied between 18.5 % and 5.1%. •PIC increased costs by €0.59 (price of a stamp) per girl, and €450.69 per extra girl vaccinated
Mantzari 2015	England, UK	–	Randomized controlled trial	16-to-18-year-old girls	Total: 1000	•HPV vaccine series coverage; initiation and completion	•Invitation letters only •Invitation letters plus financial incentive vouchers worth £45 (£20 for 1st dose, £5 for 2nd dose, £20 for 3rd dose)	•Financial incentives significantly increased initial uptake of the HPV-vaccination program by ∼ 10% •Interventions increase series completion by ∼ 10%
Morris 2015	California, USA	–	Randomized controlled trial	11-to-17-year-olds	Intervention groups: 1,797Phone call only: 3,253Unsampled controls: 116,356	•HPV vaccine series initiation •HPV vaccine series completion •Up-to-date (UTD) status •Time to UTD •Cost efficiency of reminder methods	•Phone call only or phone call plus one of three reminder options: •Text messages •Email •Postcard	•UTD status reach by 32.1% of text message recipients, 23.3% for postcards, 20.8% for emails, and 12.4% for participants who received enrollment phone call only. •Mean costs for were $4.65 per postcard, $3.09 per e-mail, and $3.09 per text message enrollees. •The average cost for each text recipient to become UTD was $9.63 compared to $14.86 per UTD e-mail recipient and $20.22 per UTD postcard recipient.
O’Leary 2015	Colorado, USA	–	Randomized controlled trial	11-to-17-year-olds	Intervention: 2,228Controls: 2,359	•Uptake of any needed HPV vaccine dose •Missed opportunity for vaccination. •Cost of short messaging service (SMS)	•Practice initiated SMS with parents choosing one of 3 options: •Clinic call parent to schedule •Parent call clinic to schedule •None	•19% of intervention group compared to 15% of the control group received at least one dose of HPV vaccine •Responding that the clinic should call to schedule was associated with the highest effect size for completion of all needed services. •Net cost ranged from $855 to $3394 per practice. •Average costs per child were $2.64 to $10.48.
Szilagyi 2013	New York, USA	–	Random selection of participants. Participants select choice of intervention	11-to-17-year-olds		•Immunization rates for preventive vaccines (HPV for girls only)	•Mailed reminder •Telephone reminder	•HPV vaccine series uptake was similar across intervention groups (27% for 1st dose, 26% for 2nd dose, and 18% to 19% for 3rd dose). •The intervention cost $18.78 for mailed or $16.68 for phone per adolescent per year to deliver •The cost per additional adolescent fully vaccinated was $463.99 for mailed and $714.98 for telephone

CDS - decision support for clinicians. FFI – family focused intervention/automated decision support to families. FIG - fully immunized girl.