, Volume 27, Issue 2, pp 127–147 | Cite as

Effectiveness and Cost Effectiveness of Human Papillomavirus Vaccine

A Systematic Review
  • Fawziah Marra
  • Karine Cloutier
  • Bridgette Oteng
  • Carlo Marra
  • Gina Ogilvie
Review Article


The recent approval of human papillomavirus (HPV) vaccine means that decision makers need information beyond that available from randomized clinical trials to recommend funding for this vaccination programme. Modelling and economic studies have addressed some of those information needs. We conducted a qualitative systematic review to summarize the existing data. Review articles were obtained from an extensive literature search on studies using mathematical modelling (either a Markov or transmission dynamic model) to determine the effectiveness or cost effectiveness of an HPV vaccine compared with the current cytology-based Pap smear screening programme.

A total of 21 studies (but 22 models) were included in the review after being assessed for methodological quality. All of the included studies had used a mathematical model to determine the effectiveness of an HPV vaccine, whilst 13 had also conducted a cost-effectiveness analysis. Although the studies used different model structures, baseline parameters and assumptions, all studies showed that vaccination would decrease rates of HPV infection, precancerous lesions and cervical cancer. Studies had a consistent message with respect to cost effectiveness: a female-only vaccination programme is cost effective compared with the current cytology-based Pap smear screening programme, while the cost effectiveness of a male and female vaccination programme is generally not cost effective compared with female-only vaccination.


Cervical Cancer Cervical Intraepithelial Neoplasia Vaccine Efficacy Genital Wart Invasive Cervical Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



G. Ogilvie has previously received grants from Merck and Co. for an investigator-driven study on prevalence of HPV in British Columbia, Canada. The other authors have no conflicts of interest that are directly relevant to the content of this review. No sources of funding were used to assist in the preparation of this review.

Supplementary material

40273_2012_27020127_MOESM1_ESM.pdf (276 kb)
Supplementary material, approximately 282 KB.


  1. 1.
    Bosch FX, Lorincz A, Muñoz N, et al. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002; 55: 244–65PubMedCrossRefGoogle Scholar
  2. 2.
    Goodman A. Primary vaginal cancer. Surg Oncol Clin N Am 1998; 7: 347–61PubMedGoogle Scholar
  3. 3.
    Jones RW, Rowan DM, Stewart AW. Vulvar intraepithelial neoplasia: aspects of the natural history and outcome in 405 women. Obstet Gynecol 2005; 106: 1319–26PubMedCrossRefGoogle Scholar
  4. 4.
    Dianzani C, Calvieri S, Pierangeli A, et al. Identification of human papilloma viruses in male dysplastic genital lesions. New Microbiol 2004; 27: 65–9PubMedGoogle Scholar
  5. 5.
    McKaig RG, Baric RS, Olshan AF. Human papillomavirus and head and neck cancer: epidemiology and molecular biology. Head Neck 1998; 20: 250–65PubMedCrossRefGoogle Scholar
  6. 6.
    Greer CE, Wheeler CM, Ladner MB, et al. Human papillomavirus (HPV) type distribution and serological response to HPV type 6 virus-like particles in patients with genital warts. J Clin Microbiol 1995; 33: 2058–63PubMedGoogle Scholar
  7. 7.
    Derkay CS, Darrow DH. Recurrent respiratory papillomatosis of the larynx: current diagnosis and treatment. Otolaryngol Clin North Am 2000; 33: 1127–42PubMedCrossRefGoogle Scholar
  8. 8.
    Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer 2006; 118: 3030–44Google Scholar
  9. 9.
    Ferlay J, Bray F, Pisani P, et al. GLOBOCAN 2002. Cancer incidence, mortality and prevalence worldwide. IARC CancerBase No.5, Version 2.0. Lyon: IARC Press, 2004Google Scholar
  10. 10.
    Muñoz N, Bosch FX, De Sanjosé S, et al., International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003; 348: 518–27PubMedCrossRefGoogle Scholar
  11. 11.
    Merck Frosst. Gardasil®: quadrivalent human papillomavirus (types 6,11,16,18) recombinant vaccine [product monograph]. Date of revision: 2007 Jun 26 [online]. Available from URL: [Accessed 2008 Jun 18]
  12. 12.
    GlaxoSmithKline. Cervarix™: human papillomavirus (types 16,18) recombinant adjuvanted, adsorbed vaccine [product monograph]. Date of revision: 2007 Sep [online]. Available from URL:
  13. 13.
    Koutsky LA, Ault KA, Wheeler CM, et al. A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med 2002; 347: 1645–51PubMedCrossRefGoogle Scholar
  14. 14.
    Mao C, Koutsky LA, Ault KA, et al. Efficacy of human papillomavirus-16 vaccine to prevent cervical intraepithelial neoplasia: a randomized controlled trial. Obstet Gynecol 2006; 107: 18–27PubMedCrossRefGoogle Scholar
  15. 15.
    Villa LL, Costa RL, Petta CA, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol 2005; 6: 271–8PubMedCrossRefGoogle Scholar
  16. 16.
    Villa LL, Ault KA, Giuliano AR, et al. Immunologic responses following administration of a vaccine targeting human papillomavirus types 6, 11, 16, and 18. Vaccine 2006; 24: 5571–83PubMedCrossRefGoogle Scholar
  17. 17.
    Villa LL, Costa RL, Petta CA, et al. High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer 2006; 95: 1459–66PubMedCrossRefGoogle Scholar
  18. 18.
    Harper DM, Franco EL, Wheeler CM, et al., HPV Vaccine Study group. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet 2006; 367: 1247–55PubMedCrossRefGoogle Scholar
  19. 19.
    Harper DM, Franco EL, Wheeler C, et al., GlaxoSmithKline HPV Vaccine Study Group. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet 2004; 364: 1757–65PubMedCrossRefGoogle Scholar
  20. 20.
    Barr E, Tamms G. Quadrivalent human papillomavirus vaccine. Clin Infect Dis 2007; 45 (5): 609–7PubMedCrossRefGoogle Scholar
  21. 21.
    Garnett GP, Kim JJ, French K, et al. Chapter 21: modelling the impact of HPV vaccines on cervical cancer and screening programmes. Vaccine 2006; 24 Suppl. 3: S178–86CrossRefGoogle Scholar
  22. 22.
    Dasbach EJ, Elbasha EH, Insinga RP. Mathematical models for predicting the epidemiologic and economic impact of vaccination against human papillomavirus infection and disease. Epidemiol Rev 2006; 28: 88–100PubMedCrossRefGoogle Scholar
  23. 23.
    Newall AT, Beutels P, Wood JG, et al. Cost-effectiveness analyses of human papillomavirus vaccination. Lancet Infect Dis 2007; 7: 289–96PubMedCrossRefGoogle Scholar
  24. 24.
    Goldie S, Goldhaber-Fiebert JD, Garnett GP. Chapter 18: public health policy for cervical cancer prevention. The role of decision science, economic evaluation, and mathematical modeling. Vaccine 2006; 24 Suppl 3: S155–63CrossRefGoogle Scholar
  25. 25.
    Drummond MF, Richardson WS, O’Brien BJ, et al. User’s guides to the medical literature: XII. How to use an article on economic analysis of clinical practice: A. Are the results of study valid? JAMA 1997; 207 (19): 1552–7CrossRefGoogle Scholar
  26. 26.
    Hughes JP, Garnett GP, Koutsky L. The theoretical population-level impact of a prophylactic human papilloma virus vaccine. Epidemiology 2002; 13: 631–9PubMedCrossRefGoogle Scholar
  27. 27.
    Sanders GD, Taira AV. Cost effectiveness of a potential vaccine for human papillomavirus. Emerg Infect Dis 2003; 9: 37–48PubMedCrossRefGoogle Scholar
  28. 28.
    Kulasingam SL, Myers ER. Potential health and economic impact of adding human papillomavirus vaccine to screening programs. JAMA 2003; 290: 781–9PubMedCrossRefGoogle Scholar
  29. 29.
    Goldie SJ, Grima D, Kohli M, et al. A comprehensive natural history model of HPV infection and cervical cancer to estimate the clinical impact of a prophylactic HPV-16/18 vaccine. Int J Cancer 2003; 106: 896–904PubMedCrossRefGoogle Scholar
  30. 30.
    Goldie SJ, Kohli M, Grima D, et al. Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst 2004; 96: 604–15PubMedCrossRefGoogle Scholar
  31. 31.
    Kohli M, Ferko N, Martin A, et al. Estimating the long-term impact of a prophylactic human papillomavirus 16/18 vaccine on the burden of cervical cancer in the UK. Br J Cancer 2007; 96: 143–50PubMedCrossRefGoogle Scholar
  32. 32.
    UK Department of Health. Cervical screening program, England: 2003–04. Statistical Bulletin 2004/20 [online]. Available from URL: [Accessed 2008 Dec 30]
  33. 33.
    Brisson M, Van de Velde N, De Wals P, et al. The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada. Vaccine 2007; 25: 5399–408PubMedCrossRefGoogle Scholar
  34. 34.
    Kulasingam S, Connelly L, Conway E, et al. A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sexual Health 2007; 4: 165–75PubMedCrossRefGoogle Scholar
  35. 35.
    Kulasingam SL, Benard S, Barnabas RV, et al. Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: a cost-effectiveness analysis. Cost Eff Resour Alloc 2008; 6 (1): 4–15PubMedCrossRefGoogle Scholar
  36. 36.
    Bergeron C, Largeron N, McAllister R, et al. Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France. Int J Technol Assess Health Care 2008; 24 (1): 10–9PubMedCrossRefGoogle Scholar
  37. 37.
    Taira AV, Neukermans CP, Sanders GD. Evaluating human papillomavirus vaccination programs. Emerg Infect Dis 2004; 10: 1915–23PubMedCrossRefGoogle Scholar
  38. 38.
    Barnabas RV, Laukkanen P, Koskela P, et al. Epidemiology of HPV 16 and cervical cancer in Finland and the potential impact of vaccination: mathematical modelling analyses. PLoS Med 2006; 3: e138Google Scholar
  39. 39.
    French KM, Barnabas RV, Lehtinen M, et al. Strategies for the introduction of human papillomavirus vaccination: modelling the optimum age- and sex-specific pattern of vaccination in Finland. Br J Cancer 2007; 96: 514–8PubMedCrossRefGoogle Scholar
  40. 40.
    Elbasha EH, Dasbach EJ, Insinga RP. Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis 2007; 13: 28–41PubMedCrossRefGoogle Scholar
  41. 41.
    Günther OP, Ogilvie G, Naus M, et al. Protecting the next generation: what is the role of the duration of human papillomavirus vaccine-related immunity? J Infect Dis 2008; 197 (12): 1653–61PubMedCrossRefGoogle Scholar
  42. 42.
    BC Cancer Agency. 2005 annual report. Vancouver (BC): The Cervical Cancer Screening Program, 2005 [online]. Available from URL: [Accessed 2007 Oct 24]
  43. 43.
    Insinga RP, Dasbach EJ, Elbasha EH, et al. Cost-effectiveness of quadrivalent human papillomavirus (HPV) in Mexico: a transmission dynamic model-based evaluation. Vaccine 2007; 26: 128–39PubMedCrossRefGoogle Scholar
  44. 44.
    Regan DG, Philp DJ, Hocking JS, et al. Modelling the population-level impact of vaccination on the transmission of human papillomavirus type 16 in Australia. Sexual Health 2007; 4: 147–63PubMedCrossRefGoogle Scholar
  45. 45.
    Kim JJ, Andres-Beck B, Goldie SJ. The value of including boys in an HPV vaccination programme: a cost-effectiveness analysis in a low-resource setting. Br J Cancer 2007; 97: 1322–8PubMedCrossRefGoogle Scholar
  46. 46.
    Measure DHS. Demographic and health surveys [online]. Available from URL: [Accessed 2007 Jan 19]
  47. 47.
    United Nations Population Division. World population prospects: the 2004 revision population database [online]. Available from URL: [Accessed 2007 Jan 19]
  48. 48.
    US Census Bureau. Population estimates program. Washington, DC: US Census Bureau, Population Division, 2000 [online]. Available from URL: [Accessed 2007 Sep 24]
  49. 49.
    Goldie SJ, Kim JJ, Kobus K, et al. Cost-effectiveness of HPV 16, 18 vaccination in Brazil. Vaccine 2007 Aug 14; 25 (33): 6257–70PubMedCrossRefGoogle Scholar
  50. 50.
    Yang BH, Bray FI, Parkin DM, et al. Cervical cancer as a priority for prevention in different world regions: an evaluation using years of life lost. Int J Cancer 2004; 109 (3): 418–24.PubMedCrossRefGoogle Scholar
  51. 51.
    Goldhaber-Fiebert JD, Stout NK, Ortendahl J, et al. Modeling human papillomavirus and cervical cancer in the United States for analyses of screening and vaccination. Popul Health Metr 2007; 5: 11PubMedCrossRefGoogle Scholar
  52. 52.
    Chesson HW, Ekwueme DU, Saraiya M, et al. Cost-effectiveness of human papillomavirus vaccination in the United States. Emerg Infect Dis 2008 Feb; 14 (2): 244–51PubMedCrossRefGoogle Scholar
  53. 53.
    Stratton KR, Durch J, Lawrence RS. Vaccines for the 21st century: a tool for decision making. Institute of Medicine (US): Committee to Study Priorities for Vaccine Development. Washington, DC: National Academy Press, 2000Google Scholar
  54. 54.
    Gold MR, Siegel JE, Russel LB, et al., editors. Cost-effectiveness in health and medicine. New York Oxford University Press, 1996Google Scholar
  55. 55.
    Curtis L, Netten A. Unit costs of health and social care 2005. Kent (UK): University of Kent, PSSRU, 2005Google Scholar
  56. 56.
    Ortega-Sanchez IR, Lee GM, Jacobs RJ, et al., Working Group on Leading Economic Issues for New Vaccine for Adolescents. Projected cost-effectiveness of new vaccines for adolescents in the United States. Pediatrics 2008; 121 Suppl. 1: S63–78CrossRefGoogle Scholar
  57. 57.
    Newall AT, Beutels P, Wood JG, et al. Cost-effectiveness analyses of human papillomavirus vaccination. Lancet Infect Dis 2007 Apr; 7 (4): 289–96PubMedCrossRefGoogle Scholar
  58. 58.
    Myers ER, Green S, Lipkus I. Patient preferences for health states related to HPV infection: visual analog scales versus time trade off elicitation. Proceedings of the 21st International Papillomavirus Conference; 2004 Feb 20–27; Mexico CityGoogle Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Fawziah Marra
    • 1
    • 2
  • Karine Cloutier
    • 3
  • Bridgette Oteng
    • 1
  • Carlo Marra
    • 1
    • 4
  • Gina Ogilvie
    • 1
    • 2
  1. 1.University of British ColumbiaVancouverCanada
  2. 2.British Columbia Centre for Disease ControlVancouverCanada
  3. 3.University of LavalQuebec CityCanada
  4. 4.Centre for Health Evaluation and Outcomes SciencesVancouverCanada

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