Introduction To evaluate the health impact and economic benefits of one dose or two doses of 2-valent (2vHPV), 4-valent (4vHPV), or 9-valent (9vHPV) HPV vaccine compared to no vaccination along with primary HPV testing in a low/middle income country setting, specifically in Thailand.

Methods A Markov model was used to simulate HPV infection and cervical cancer in a cohort of 100,000 12-year-old HPV-naive girls. The study compared nine strategies: one dose and two doses of 2vHPV (Cervarix®), 2vHPV (Cecolin®), 4vHPV (Gardasil®), 9vHPV vaccine (Gardasil9®), and no vaccination. Main outcome measure was quality-adjusted life year (QALY) of each strategy. Incremental cost-effectiveness ratios (ICER) were estimated over a lifetime horizon, univariate and probabilistic sensitivity analyses were conducted for uncertain variables in different scenarios.

Results In the base case scenario, all vaccination programs resulted in 41,298–71,057 QALYs gained with a cost saving of 14,914,186–19,821,655 USD compared to no vaccination. Based on the incremental analysis, two doses of 9vHPV vaccine was the most cost-effective strategy with an ICER of 406 USD/QALY. Sensitivity analysis showed that the probability of being cost-effective for two doses of 9vHPV vaccine was 80%, and uncertainty around the costs of vaccination and vaccine efficacy caused the largest variation in the cost-effectiveness findings.

Conclusion/Implications Two doses of 9vHPV vaccine along with a primary HPV test for screening program represent the most cost-effective option for school-based HPV vaccination of 12-year-old girls in Thailand, with a lower willingness to pay of one time the per-capita GDP. This finding provides important evidence to policymakers for cervical cancer prevention.