Micro-Costing Analysis for Human Papillomavirus (HPV) Vaccination Services for Out-of-School (OOS) Girls in Indonesia: Evidence from a Pilot Study

Cervical cancer remains a major public health challenge in Indonesia, with Human Papillomavirus (HPV) infection responsible for nearly all cases. 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. Micro-costing approach was used to estimate both economic and financial costs of delivering HPV vaccination to OOS girls in Bekasi City, Bandar Lampung City, and Bangka District. This study aimed to estimate the cost of delivering a single-dose HPV vaccination program to OOS girls and to project the national-level cost of scaling up the program. Costs were categorized into outreach efforts, such as community mobilization and identification of girls, and delivery components including logistics, storage, and administration. A scale-up costing analysis was also conducted to estimate national-level costs. The results show that the cost per vaccinated OOS girl aged 11 ranged from US$ 22.77 to 38.55, while the financial cost range from US$ 12.70 to 29.50, varied by implementation context, with outreach activities, transportation, and vaccine delivery supplies identified as the main cost drivers. The estimated national annual economic and financial cost of scaling-up HPV vaccination for OOS girls are US$ 644,215.23 and US$ 483,138.35, respectively. Our national cost estimates show that reaching and vaccinating OOS girls accounts for less than 3% of the national immunization budget. Factors such as local context and implementation challenges should be recognized as they may directly influence the cost and hinder the program scale-up.