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RESEARCH PAPER ANALYSIS

Cost-effectiveness of different HPV vaccination strategies for cervical cancer prevention in South Africa.

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PMID40992075
JournalVaccine
Publication Date2025-09-22
Ingested2026-08-02 12:05 AM
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ABSTRACT

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BACKGROUND: Most cervical cancers can be prevented by population-wide vaccination of pre-adolescent girls with highly efficacious HPV vaccines. In South Africa, first-dose coverage of bivalent HPV vaccination among girls aged 10 is ∼80 %. We investigated the additional impact and cost-effectiveness of different bivalent and nonavalent vaccination strategies among the general population and women with HIV (WHIV). METHODS: We used an individual-based, population-level model for HPV and HIV transmission in South Africa to estimate the epidemiological impact of HPV vaccination. The costs of interventions in the cervical cancer care cascade are estimated in 2024 USD based on resource use and prices obtained from research studies. To estimate cost-effectiveness of different bivalent strategies, we calculated the median cost per disability adjusted life-year averted (DALY) between 2024 and 2120 and compared it to an opportunity cost (OC) threshold of USD 3015. We calculated a threshold price at which nonavalent vaccination will be cost-effective in South Africa. RESULTS: Current interventions are projected to reduce age-standardised cervical cancer incidence from 54 to 12 per 100,000 women by 2120. Increasing girl-only bivalent coverage to 90 % would prevent an additional 5 % of cases and be cost-saving. Gender-neutral vaccination at 80 % coverage would yield similar impact, with a USD/DALY averted of USD 2782 compared to girls-only vaccination. Vaccinating WHIV up to age 45 could prevent 10 % of cervical cancer cases in this group and remains cost-effective. The nonavalent vaccine would be cost-effective if priced below USD 40 per dose. CONCLUSION: Enhanced HPV vaccination strategies-including higher coverage, gender-neutral programs, and targeted vaccination of WHIV-are cost-effective in South Africa. However, no vaccination strategy alone will reach elimination, which will require integrated approaches combining vaccination with cervical cancer screening and treatment.

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Cost-effectiveness of different HPV vaccination strategies for cervical cancer prevention in South Africa.

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