Abstract
OBJECTIVE: To evaluate the cost-effectiveness of introducing Human Papillomavirus (HPV) vaccination into Türkiye's National Immunization Program. METHODS: The analysis employed the WHO-endorsed PRIME model in Microsoft Excel. Two vaccination strategies were simulated for 12-year-old girls: Scenario 1 (bivalent or quadrivalent vaccine) and Scenario 2 (nonavalent vaccine). Each scenario was assessed from both the Social Security Institution (SGK) and societal perspectives. Incremental cost-effectiveness ratios (ICERs) were calculated per disability-adjusted life year (DALY) averted, with sensitivity analyses conducted to test model robustness. RESULTS: Scenario 1 yielded an ICER of USD 2,231 per DALY averted, while Scenario 2 produced an ICER of USD 2,342. The incremental ICER of Scenario 2 versus Scenario 1 was USD 2,592. According to WHO cost-effectiveness thresholds, both scenarios were classified as "very cost-effective." Sensitivity analyses identified the discount rate as the most influential factor, followed by vaccine efficacy, HPV subtype distribution, and vaccine price. The annual program cost to SGK was estimated at USD 15.7 million for Scenario 1 and USD 23.6 million for Scenario 2. Vaccination remained highly cost-effective at prices up to USD 54 (Scenario 1) and USD 78 (Scenario 2), but not cost-effective above USD 167 and USD 242, respectively. CONCLUSIONS: HPV vaccination is highly cost-effective in Türkiye, with both strategies offering substantial health gains and favorable ICERs well below national GDP per capita. Adoption of a national HPV vaccination program would likely reduce cervical cancer morbidity and mortality while representing an efficient use of healthcare resources.