OBJECTIVES: To estimate clinical outcomes and cost-offset (cost-benefit) from a societal perspective expected from human papilloma virus (HPV) vaccination in the Moscow region (MR). METHODS: A static population model developed in MS Excel was adapted to the MR setting. The model estimated the annual number of abnormal Papanicolaou smear test (abnormal PAP), precancerous lesions (cervical intraepithelial neoplasia (CIN)) and cervical cancer (CC) as well as costs (RUB) associated with treatment and productivity loss over a one year period at vaccine steady state (i.e. when all women are vaccinated), current vs. future burden assuming 95% vaccine coverage. The MR incidence data on abnormal PAP and CINs were extrapolated from the relative proportion of abnormal PAP, precancerous lesions and CC previously published. Vaccination effectiveness was based on clinical trial data and HPV distribution for Russia and Eastern Europe. Medical costs were estimated from resources used and listed Russian price. Indirect costs include unpaid taxes, illness allowance and regional GDP foregone. No discount was applied. Sensitivity analyses were conducted on main parameters (number of lesions, vaccine effectiveness, costs). RESULTS: Vaccination with the bivalent HPV vaccine in the MR was estimated to prevent 13,737 abnormal PAP (112.6 m.rub.), 11,750 CIN1 (296.1 m.rub.), 4,222 CIN2/3 (259.3 m.rub.), 504 CC (98.9 m.rub.), 199 cases of lifelong disability (44.6 m.rub.) and 276 cases of CC deaths annually. Total cost offsets could amount to 811.6 m.rub. (664.8 m.rub. treatment cost only) representing 2.5x annual cost of vaccinating one cohort of 12 year-old girls (328.9 m.rub.) (2.0x vs. treatment cost only). The benefit-to-cost ratio (cost offset/vaccination cost) ranged from 1.8 to 3.1 over the sensitivity analyses. CONCLUSIONS: Implementation of HPV vaccination in the MR could significantly decrease cervical HPV-infection disease-related burden. The cost of vaccination, at steady state, could be fully compensated by the cost offset.