Intended for healthcare professionals


Economic evaluation of human papillomavirus vaccination in the United Kingdom

BMJ 2008; 337 doi: (Published 17 July 2008) Cite this as: BMJ 2008;337:a769
  1. Mark Jit, health economist and mathematical modeller,
  2. Yoon Hong Choi, mathematical modeller,
  3. W John Edmunds, head of modelling and economics unit
  1. 1Modelling and Economics Unit, Centre for Infections, Health Protection Agency, London NW9 6BT
  1. Correspondence to: M Jit mark.jit{at}
  • Accepted 8 July 2008


Objective To assess the cost effectiveness of routine vaccination of 12 year old schoolgirls against human papillomavirus infection in the United Kingdom.

Design Economic evaluation.

Setting UK.

Population Schoolgirls aged 12 or older.

Main outcome measures Costs, quality adjusted life years (QALYs), and incremental cost effectiveness ratios for a range of vaccination options.

Results Vaccinating 12 year old schoolgirls with a quadrivalent vaccine at 80% coverage is likely to be cost effective at a willingness to pay threshold of £30 000 (€37 700; $59 163) per QALY gained, if the average duration of protection from the vaccine is more than 10 years. Implementing a catch-up campaign of girls up to age 18 is likely to be cost effective. Vaccination of boys is unlikely to be cost effective. A bivalent vaccine with the same efficacy against human papillomavirus types 16 and 18 costing £13-£21 less per dose (depending on the duration of vaccine protection) may be as cost effective as the quadrivalent vaccine although less effective as it does not prevent anogenital warts.

Conclusions Routine vaccination of 12 year old schoolgirls combined with an initial catch-up campaign up to age 18 is likely to be cost effective in the UK. The results are robust to uncertainty in many parameters and processes. A key influential variable is the duration of vaccine protection.


  • We thank Ruby Siddiqui for information on the literature about cost and quality of life implications of human papillomavirus associated infections, Sue Westlake and the Office for National Statistics for providing incidence data on cervical cancer, Zia Sadique for statistical advice, the panel of referees who commented on an earlier version of this work, and Kate Soldan, Nigel Gay, and Elizabeth Miller for helpful discussions.

  • Contributors: MJ and WJE designed the study. MJ, WJE, and YHC carried out the computer simulations and analysis. MJ drafted the manuscript with input from WJE and YHC. All authors approved the final version to be published. MJ is the guarantor.

  • Funding: This work was funded by grants from the Department of Health Policy Research programme [reference Nos DOH 039/0030 and DOH 039/031]. The authors’ work was independent of the funders, who had no role in the study design, analysis of data, writing of the manuscript, or decision to submit for publication.

  • Competing interests: WJE’s partner works for GlaxoSmithKline.

  • Ethical approval: Not required.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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