Cost-Effectiveness of Nationwide HPV Vaccination in Girls in Kazakhstan: A UNIVAC-Based Analysis

Background: Cervical cancer, largely attributable to persistent infection with high-risk human papillomavirus (HPV), remains a major public health burden worldwide, including in Kazakhstan, where limited screening coverage and low public awareness contribute to substantial incidence and mortality. This study evaluated the cost-effectiveness and epidemiological impact of a nationwide HPV vaccination programme for 10-year-old girls in Kazakhstan using the quadrivalent Gardasil-4 vaccine. Methods: A 10-year modelling analysis (2025-2035) was conducted using the World Health Organization (WHO)-endorsed Universal Vaccination Impact and Cost-Effectiveness Assessment (UNIVAC) tool adapted to Kazakhstan-specific epidemiological and economic parameters. Vaccination coverage was projected at 98.0% for the first dose and 96.5% for the second dose. Incremental cost-effectiveness ratios (ICERs) and disability-adjusted life years (DALYs) averted were estimated from governmental and societal perspectives. Sensitivity analyses assessed uncertainty in vaccine coverage, vaccine costs, and epidemiological inputs. Results: Over the 10-year period, the vaccination programme was projected to reduce HPV-related disease cases by 68.2% (from 112,198 to 35,628) and deaths by 68.3% (from 15,921 to 5056), while averting 67,445 DALYs. The ICER was estimated at US$ 533 per DALY averted from the governmental perspective and US$ 1169 from the societal perspective. Projected healthcare cost savings reached US$ 42.8 million, driven largely by reductions in 21,748 hospitalisations and 13,706 outpatient visits. These findings remained robust in probabilistic sensitivity analysis, with the probability of cost-effectiveness increasing as the willingness-to-pay threshold rose. Conclusions: UNIVAC-based modelling suggests that introduction of a national HPV vaccination programme for 10-year-old girls in Kazakhstan using Gardasil-4 could substantially reduce cervical cancer burden and related mortality while generating considerable healthcare savings. These findings support the cost-effectiveness of nationwide HPV vaccination in Kazakhstan.