bined with current cervical cancer screening and HPV disease treatment practices in Turkey. For the vaccination strategy 85% coverage rate was assumed in the frame of a mandatory school-based program. Reference strategy was current cervical cancer screening and HPV disease treatment practices in Turkey. Costs were estimated from the perspective of the Turkish healthcare system, using direct medical costs associated with the diagnosis and treatment of cervical diseases. RESULTS: Over 100 years, cumulative % (absolute) reduction in the incidence of 6/11/16/18-related cases of CIN1, CIN2/3, cervical cancer, cervical cancer deaths, genital warts-female, and genital-warts-male was 78% (4,894), 72% (32,537), 57% (73,277), 54% (40,513), 86% (404,674), and 86% (409,029), respectively, in the vaccination group compared to the reference group. Number of 6/11/16/18-related CIN1, CIN2/3, cervical cancer, cervical cancer deaths, and genital warts (both in female and male population) was halved in the vaccination strategy group compared to the reference strategy group by year 19, 24, 41, 44, and 14, respectively. The incremental cost-effectiveness ratio for routine vaccination of 12-year-old girls was 18,251 TRY/QALY over 100 years. CONCLUSIONS: A quadrivalent HPV vaccination program can reduce the incidence of cervical cancer, CINs and genital warts in Turkey at a cost-per-QALY ratio within the range defined as cost effective.
