Email updates

Keep up to date with the latest news and content from BMC Infectious Diseases and BioMed Central.

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

For all author emails, please log on.

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.