Bashari and colleagues evaluate whether introducing HPV vaccination would be a good use of health resources in Iran by comparing three products—bivalent, quadrivalent, and nine-valent vaccines—against no vaccination in a lifetime Markov model of 100,000 12-year-old girls. Using Iran-specific data on HPV type distribution, cervical cancer (CC) incidence, and treatment costs, the model tracks HPV infection through precancerous lesions, CC, genital warts (GW), and death. Clinically, the nine-valent vaccine delivers the largest health gains: at 100% coverage it is projected to avert 98.4% of cervical cancers and 99% of CC deaths, while substantially reducing CIN and genital warts; the bivalent vaccine offers stronger protection against CIN and cancer than the quadrivalent product but no benefit for GW. These results highlight the strong potential health impact of HPV vaccination, even in a relatively low-incidence setting.
From an economic perspective, however, current vaccine prices are a binding constraint. Using a one-times-GDP-per-capita threshold of US$4,761.90 per QALY (2019), none of the vaccination strategies are considered cost-effective: the lowest incremental cost-effectiveness ratio (ICER) is US$33,179 per QALY for the two-dose bivalent schedule, rising to US$45,088 and US$50,067 per QALY for quadrivalent and nine-valent vaccines, respectively—well above the chosen threshold and roughly 7–11 times Iran’s GDP per capita. Deterministic and probabilistic sensitivity analyses confirm that no vaccination remains the preferred option across plausible parameter ranges, and that vaccines would only become cost-effective if prices fell by roughly 82–85% (to about US$6.95, US$12.88, and US$13.44 per dose for bivalent, quadrivalent, and nine-valent products). The authors conclude that, given Iran’s low cervical cancer incidence (ASIR 2.2 per 100,000 women) and high vaccine prices, HPV vaccination is not currently an efficient national investment, underscoring the importance of context-specific modelling and substantial price reductions or alternative financing arrangements if such programs are to be justified on economic grounds.
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