OBJECTIVES: Human papillomavirus (HPV) vaccination has shown to be highly effective in preventing HPV-related diseases and cancers. Several modeling analyses evaluating cost-effectiveness of HPV vaccination and time to cervical cancer elimination (CCE) have been published. We aim to systematically summarize modeling studies of HPV vaccine cost-effectiveness (CE) and CCE.

METHODS: Databases of MEDLINE, Embase and Cochrane were screened via dual review to identify studies that evaluated CE or CCE of quadri- (4vHPV) and nonavalent vaccines (9vHPV).

RESULTS: 113 CE and 13 CCE publications were identified, including 99 studies in primary adolescent (66 girls-only vaccination (GOV), 33 gender-neutral vaccination (GNV)), 19 in catch-up cohorts (≥18 years, young or mid-adult), and 6 targeted men who have sex with men (MSM) vaccination. Dynamic transmission modeling including herd effects were applied in most studies. The majority considered lifetime protection (n=100) In almost of all studies, the GOV program was considered cost-effective compared to screening alone. Often, GNV versus GOV and/or screening was cost-effective, at the relevant CE threshold, if female coverage rates accounted for herd effects and all male HPV-related diseases were included in the model. GOV and GNV 9vHPV vaccination were considered cost-effective compared to 4vHPV and screening alone but varied with factors like vaccine price, coverage rates and population disease burden. Catch-up vaccination programs for women have shown favorable cost-effectiveness depending on the studies age cohort. CE of vaccination for MSM was inconclusive due to limited evidence. In a high-income country setting where national immunization programs have been implemented shortly after 2006 and HPV vaccination was introduced with high coverage rate along with established effective organized screening programs, CCE could be expected by 2028-2059.

CONCLUSIONS: A wide range of modeling studies in different populations and vaccination strategies support HPV vaccination as a cost-effective strategy to prevent HPV-related diseases.