Open Access Research article

Estimated health and economic impact of quadrivalent HPV (types 6/11/16/18) vaccination in Brazil using a transmission dynamic model

Kosuke Kawai1*, Gabriela Tannus Branco de Araujo2, Marcelo Fonseca23, Matthew Pillsbury4 and Puneet K Singhal5

Author Affiliations

1 Temple University, 3307 N. Broad Street, Philadelphia, PA, 19140, USA

2 Axia.Bio, São Paulo, Brazil

3 Federal University of São Paulo – UNIFESP, São Paulo, Brazil

4 Atlas Data Systems, Westfield, NJ, 07090, USA

5 Merck & Co., Inc., West Point, PA, 19486, USA

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BMC Infectious Diseases 2012, 12:250  doi:10.1186/1471-2334-12-250

Published: 9 October 2012



Cervical cancer is the second most common cancer among women in Brazil. We examined the health and economic impacts of quadrivalent HPV vaccination in Brazil.


We adapted a previously developed transmission dynamic model to estimate the effectiveness of HPV vaccination on cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3), CIN1, and genital warts. We evaluated following vaccination strategies: routine vaccination of 12-year-old girls and routine vaccination in combination with a catch-up vaccination of 12 to 26-year-old women.


The model projected that the vaccination would reduce the incidence rates of HPV 6/11/16/18-related cervical cancer, CIN2/3, CIN1, and female genital warts by 94% to 98% at year 100. Routine vaccination in combination with a catch-up vaccination could prevent approximately 163,000 cases of cervical cancer, 48,000 deaths from cervical cancer, 2.3 million cases of CIN2/3, and 11.4 million genital warts in the next 50 years. The incremental cost-effectiveness ratios for female vaccination strategies ranged from R$350 to R$720 (US$219 to US$450) per quality-adjusted life year (QALY) gained.


Our study demonstrates that quadrivalent HPV female vaccination can be a cost-effective public health intervention that can substantially reduce the burden of cervical diseases and genital warts in Brazil.