Cost-effectiveness analysis of different types of human papillomavirus vaccination to prevent cervical cancer in Iran

Cervical cancer (CC) remains a major public health concern, especially in low- and middle-income countries (LMICs), where prevention and screening access are limited. Iran has a relatively low incidence of CC (age-standardized incidence rate: 2.2 per 100,000 women), but a high mortality-to-incidence ratio (44%), which suggests diagnoses occur at later stages. Despite the availability of three prophylactic HPV vaccines (bivalent, quadrivalent, and nine-valent), their cost-effectiveness in Iran is still uncertain. This study evaluates the economic and health impacts of HPV vaccination strategies in Iran. A static Markov cohort model simulated the lifetime effects of HPV vaccination on a hypothetical cohort of 100,000 twelve-year-old girls. The model incorporated Iranian epidemiological data, vaccine efficacy, and direct medical costs (vaccination, screening, and treatment). Outcomes included cases of cervical intraepithelial neoplasia (CIN), CC, genital warts (G W), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses assessed robustness. The nine-valent vaccine demonstrated the highest effectiveness, reducing CC cases by 98.4% and deaths by 99%. It was followed by the bivalent vaccine, which resulted in a 95.7% reduction in CC, and the quadrivalent vaccine, which achieved a 90.4% reduction. However, none of these vaccines is cost-effective at current prices. The ICERs are significantly above Iran’s cost-effectiveness threshold of $4,761.90 per QALY (1 times the gross domestic product (GDP) per capita). Specifically, the bivalent vaccine has an ICER of $33,179/QALY, the quadrivalent $45,088/QALY, and the nine-valent $50,067/QALY. Threshold analysis showed that vaccine prices would need to decrease by 82–85% to be considered cost-effective. Probabilistic sensitivity analysis confirmed that vaccination strategies remained not cost-effective across parameter uncertainties. Although HPV vaccines provide health benefits, they are not cost-effective in Iran at current prices due to high costs and low CC rates. Substantial price reductions are needed to support nationwide HPV vaccination efforts.