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Vaccine. 2013 Aug 20;31(37):3786-804. doi: 10.1016/j.vaccine.2013.06.060. Epub 2013 Jul 3.

Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review.

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Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.


The World Health Organization recommends establishing that human papillomavirus vaccination is cost-effective before vaccine introduction. We searched Pubmed, Embase and the Cochrane Library to 1 April 2012 for economic evaluations of human papillomavirus vaccination in low and middle income countries. We found 25 articles, but almost all low income countries and many middle income countries lacked country-specific studies. Methods, assumptions and consequently results varied widely, even for studies conducted for the same country. Despite the heterogeneity, most studies conclude that vaccination is likely to be cost-effective and possibly even cost saving, particularly in settings without organized cervical screening programmes. However, study uncertainty could be reduced by clarity about vaccine prices and vaccine delivery costs. The review supports extending vaccination to low income settings where vaccine prices are competitive, donor funding is available, cervical cancer burden is high and screening options are limited.


CVG; Cervical screening; Cost-effectiveness; Developing countries; GDP; HPV; Human papillomavirus; ICER; LMIC; QALY; Vaccination; WHO; World Health Organization; cost per vaccinated girl; gross domestic product; human papillomavirus; incremental cost-effectiveness ratio; low or middle income country; quality adjusted life year

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