Introduction: HPV vaccination is both a clinically and cost-effective way to prevent HPV-related cancers. Increased focus on preventing HPV infection and HPV-related cancers has motivated development of strategies to increase adolescent vaccination rates. This analysis estimates the average cost associated with implementing programs aimed at increasing HPV vaccination from the perspective of the clinic decision makers. As providers and healthcare organizations consider vaccination initiatives, it is important for them to understand the costs associated with implementing these programs.

Methods: Healthcare provider assessment and feedback, reminders, and education; and parent education/reminder strategies were implemented in a large pediatric clinic network between October 2015 and February 2018 to improve HPV vaccination rates. A micro-costing method was used in 2018 to prospectively estimate program implementation costs with the clinic as the unit of analysis. A sensitivity analysis assessed the effects of variability in levels of participation.

Results: Assessment and feedback reports and provider education were implemented among 51 clinics at average per clinic cost of $786 and $368 respectively. Electronic vaccination reminders were delivered to providers and parents at a per clinic cost of $824. The parent education implementation cost was $2,126 per clinic.

Conclusion: The four complimentary HPV evidence-based strategies were delivered at a total cost of $157,534 or $4,749 per clinic, including staff training and participant recruitment, reaching 155,000 HPV vaccine eligible adolescents.

Key Take Away Points

  • HPV vaccination has been shown to be a cost-effective way to prevent HPV related cancers24, however the cost of strategies for increasing HPV vaccination have not been determined.

  • Provider based strategies including A&F, provider education, and reminders were implemented at costs of $35,334, $10,225, and $42,000 respectively with a complimentary parent component introduced to a random sample of clinics costing $55,228.

  • Additional training and recruitment costs equaled $6,689 and $8,058, respectively. Fixed costs represented the largest share (66%) of total costs making the results sensitive to the number of participating clinics and parents.

  • This research serves to inform implementation scientists and clinic and provider network decision-makers on the costs of implementing strategies for increasing HPV vaccination among adolescent patient populations.

Author Biography

Jarrod Eska served as principal data collector, data analyst, drafted the original and approved the final manuscript as submitted. David Lairson served as co-investigator for the project and advised on data collection and analysis. He contributed to the original manuscript and approved the final paper as submitted. Ross Shegog, C. Mary Healy, and Maria Fernandez, aided in the development and implementation of the intervention strategies, critically reviewed and revised the manuscript, and approved final draft as submitted. Stanley Spinner facilitated access to the clinic network, provided expert feedback to develop and refine intervention strategies, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Drs. Vernon and Savas served as co-principal investigators, oversaw all facets of the study, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.


The study was supported by two grants from the Cancer Prevention and Research Institute of Texas (RP150014 and PP140183).