Cost-effectiveness of human papillomavirus vaccination for adolescent girls in Punjab state: Implications for India’s universal immunization program
Open accessAbstract
BACKGROUND: Introduction of human papillomavirus (HPV) vaccination for adolescent girls is being considered in the Punjab state of India. However, evidence regarding cost‐effectiveness is sought by policy makers when making this decision. The current study was undertaken to evaluate the incremental cost per quality‐adjusted life‐years (QALYs) gained with introduction of the HPV vaccine compared with a no‐vaccination scenario. METHODS: A static progression model, using a combination of decision tree and Markov models, was populated using epidemiological, cost, coverage, and effectiveness data to determine the cost‐effectiveness of HPV vaccination. Using a societal perspective, lifetime costs and consequences (in terms of QALYs) among a cohort of 11‐year‐old adolescent girls in Punjab state were modeled in 2 alternate scenarios with and without vaccination. All costs and consequences were discounted at a rate of 3%. RESULTS: Although immunizing 1 year's cohort of 11‐year‐old girls in Punjab state costs Indian National Rupees (INR) 135 million (US dollars [USD] 2.08 million and International dollars [Int$] 6.25 million) on an absolute basis, its net cost after accounting for treatment savings is INR 38 million (USD 0.58 million and Int$ 1.76 million). Incremental cost per QALY gained for HPV vaccination was found to be INR 73 (USD 1.12 and Int$ 3.38). Given all the data uncertainties, there is a 90% probability for the vaccination strategy to be cost‐effective in Punjab state at a willingness‐to‐pay threshold of INR 10,000, which is less than one‐tenth of the per capita gross domestic product. CONCLUSIONS: HPV vaccination appears to be a very cost‐effective strategy for Punjab state, and is likely to be cost‐effective for other Indian states. Cancer 2017;123:3253‐60. © 2017 American Cancer Society.
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Our finding regarding the cost effectiveness of HPV vaccination is in line with a previous analysis done for Punjab state in India.
“Finally, our finding regarding the cost effectiveness of HPV vaccination are in line with a previous analysis done for Punjab state in India. [35]”
From Cost effectiveness of strategies for cervical cancer prevention in India (2020) · cites this paper as [35]
At the individual level, limited knowledge, cultural misconceptions, and attitudinal barriers such as fear of side effects or concerns about morality were key problems, especially among less educated or rural populations.
“At the individual level, limited knowledge, cultural misconceptions, and attitudinal barriers, such as fear of side effects or concerns about morality were key problems, especially among less educated or rural populations12,14,17,19,28,37,38.”
From Barriers to HPV vaccination among adolescent girls in India: A scoping review (2026) · cites this paper as [19]
The Introduction discusses evidence needed for HPV-vaccine policy decisions, and the Limitations discuss what the cost-effectiveness model did not include. Neither addresses individual-level barriers such as limited knowledge, misconceptions, fear of side effects, or morality concerns, including among less educated or rural populations. Searches for those barriers and for “side effects” found no supporting passage in our copy. (LLM, conf=0.76)
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Ahmadi, A., Moghadasi, M., Sadrnia, M., & Arjomandzadegan, M. (2021) · International Journal of Mycobacteriology · doi:10.4103/2212-5531.307071 · Cited by 1 · see citing works
Prinja, S., Bahuguna, P., Faujdar, D. S., Jyani, G., Srinivasan, R., Ghoshal, S., Suri, V., Singh, M. P., & Kumar, R. (2018) · Cancer · doi:10.1002/cncr.31226
Self-citationReply to When flawed modeling justifies cost‐effectiveness: Making sense of “Band‐Aid” modeling
Prinja, S., Jyani, G., Bahuguna, P., Faujdar, D. S., & Kumar, R. (2018) · Cancer · doi:10.1002/cncr.31544
Self-citationWhen flawed modeling justifies cost‐effectiveness: Making sense of “Band‐Aid” modeling
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Newtonraj, A., & Kannan, K. S. (2024) · National Journal of Community Medicine · doi:10.55489/njcm.150820244225
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Banerjee, D., & Nandwani, M. (2025) · Journal of Current Oncological Trends · doi:10.4103/jcot.jcot_11_25
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- Authors
- Prinja, S., Bahuguna, P., Faujdar, D. S., Jyani, G., Srinivasan, R., Ghoshal, S., Suri, V., Singh, M. P., & Kumar, R.
- Affiliations
- Post Graduate Institute of Medical Education and Research (IN)
- School of Public Health Post Graduate Institute of Medical Education and Research Chandigarh India
- Corresponding author
- Prinja, Shankar
- ORCID
- Venue
- Cancer
- Publisher
- Wiley
- Published
- 2017-05-04
- Volume
- 123
- Issue
- 17
- Pages
- 3253-3260
- ISSN
- 0008-543X (ISSN-L)
- 1097-0142
- OpenAlex
- W2610835229
- Cited by
- 68
- References
- 31
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 9 · 2020: 8 · 2019: 8 · 2018: 11 · 2017: 5
- FWCI
- 6.86
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Cancer (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Surgery › Genital Health and Disease
- Keywords
- HPV vaccination, cost-effectiveness, adolescent girls, cervical cancer prevention, Universal Immunization Programme, willingness-to-pay threshold
- MeSH terms
- Adolescent, Uterine Cervical Neoplasms, Cost-Benefit Analysis, Female, Humans, India, Markov Chains, Retrospective Studies, Cohort Studies, Immunization Programs, Universal Health Insurance, Papillomavirus Infections, Mass Vaccination, Papillomavirus Vaccines
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