OBJECTIVES: Cervical cancers are the second highest incidence of female cancers in Malaysia, causing high impact on nation’s health cost and patient’s quality of life that can be avoided by better screening and HPV vaccination. METHODS: This is a cross sectional study done from 2006-2009 and respondents were interviewed from six public hospitals. Methods include experts’ panel discussions to estimate treatment costs and respondents' interviews using costing and SF-36 quality of life (QOL) questionnaires. Three programs options were compared i.e. Pap smear screening; quadrivalent HPV vaccination and combined strategy (screening plus vaccination). RESULTS: 502 cervical cancer patients participated in the study. Mean age was 53.3 ± 11.21 years, educated till secondary level (39.4%), Malays (44.2%) and married for 27.73 ± 12.12 years. Life expectancy gained from vaccination is 13.04 years and average Quality Adjusted Life Years saved (QALYs) is 24.40 in vaccinated vs 6.29 in unvaccinated women. Cost/QALYs saved for Pap smear at base case is RM 1,214.96/QALYs and RM 1100.01/QALYs at increased screening coverage. In HPV vaccination, base case is at RM 35,346.79/QALYs and RM 46,530.08/QALYs when vaccination price is increased. In combined strategy, cost/QALYs at base case is RM 11,289.58/QALYs; RM 7,712.74/QALYs at best case and RM 14,590.37/QALYs at worst case scenario. Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher is highly cost effective at RM 946.74 per QALYs saved and this is followed by combined strategy at RM 35,346.67 per QALYs saved.  Budget impact analysis indicated that it cost the government RM 180.4 million per year and 2.5% of the national health budget. CONCLUSIONS: Vaccination increase life expectancy with better QOL. Cost effective strategies will include increasing the Pap smear coverage to 70% or higher. Since feasibility and long term screening adherence is doubtful among Malaysian women; vaccination of young women is more cost effective strategy against cervical cancer.