Gardasil 9 vaccination for human papillomavirus (HPV) has the potential to reduce the incidence of cervical cancer as well as overall healthcare costs if its use is more widely adopted, according to a study published in the Proceedings of the National Academy of Sciences.

The vaccine, available since 2015, protects against 9 different strains of HPV, including 5 cancer-causing strains not prevented by older vaccines. According to a team of researchers at the Yale School of Public Health and the University of Waterloo, switching to Gardasil 9 would result in greater health benefits at a similar or lower cost, despite the higher cost-per-dose of Gardasil 9.

Using a transmission model that took into account the factors affecting HPV transmission and progression of cervical cancer, the researchers found that a switch to Gardasil 9 would decrease incidence of cervical cancer by 73%, compared to 63% with older vaccines, and reduce mortality by 49% versus 43%.

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“Adopting the new vaccine is always cost-effective relative to the old vaccines,” said lead author David P Durham, PhD, associate research scientist at the Center for Infectious Disease Modeling and Analysis (CIDMA) at the Yale School of Public Health.

Additional efforts to expand HPV vaccination in states with low coverage would prevent further cancers and deaths, and increased state funding could improve both vaccination coverage and public health.

“In terms of number of cancers averted per vaccine, there are decreasing marginal returns in states that already have high coverage. You get more bang for your buck by focusing first on states with lower coverage,” Dr Durham concluded.


  1. Durham DP, Ndeffo-Mbah ML, Skrip LA, et al. National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States. P Natl Acad Sci USA. 2016; doi: 10.1073/pnas.1515528113