Cost-effectiveness analysis of different types of human papillomavirus vaccination to prevent cervical cancer in Iran
Bibliographic record
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.006 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".