OBJECTIVES:  It is estimated that almost all cervical cancers are associated with HPV infection. In most industrialised countries, cervical screening and vaccination with a bivalent or quadrivalent vaccine are recommended to prevent the disease. The current study aimed to critically review the results of CEAs that have assessed the trade-off between screening and vaccination. METHODS:  A systematic literature review was conducted in order to explore the cost-effectiveness of HPV vaccination strategies with or without different screening strategies within the geographical context of Western Europe, North America and Australia. Modelling approach, disease considered, vaccination/screening settings and costs were compared. RESULTS:  A total of 1,188 citations were identified and 20 studies were included in the review. Heterogeneity was seen across studies in terms of modelling approach, disease and prevention strategies considered. Inclusion of more HPV-related diseases significantly improves cost-effectiveness. The strategies combining screening and vaccination were found to be cost-effective when compared to vaccination or screening alone. In terms of screening strategy, HPV DNA testing with cytological triage showed a trend to be the optimal strategy in vaccinated girls. However the gain in benefits reduced as the interval between screenings is reduced. Delaying the starting age of screening could be cost saving, with a limited increase in risk of cancer. An increasing vaccine valence seemed to counterbalance the detrimental effect of delayed/less frequent screening while the total costs of cervical disease prevention/treatment may be maintained or decreased. Lastly, vaccine price seemed to affect the incremental cost-effectiveness ratio proportionally. CONCLUSIONS:  Despite heterogeneity in methodology across studies, similar trend of cost-effectiveness of competing prevention strategies was witnessed. In light of the trial results of the new nonavalent HPV vaccine, which provides protection against five additional types of the virus, the optimal prevention strategy needs to be reassessed within local context.