Abstract
<title>Abstract</title> <p>Background Cervical cancer ranks among the most common malignancies affecting women in China, and the disease burden in Guangxi Zhuang Autonomous Region is especially pronounced. Although human papillomavirus (HPV) vaccination offers the most effective form of prevention, coverage among age-eligible girls in Guangxi has remained extremely low. In 2025, domestic HPV vaccine prices dropped substantially and Guangxi launched a free vaccination program, necessitating an updated health economic evaluation under current pricing and policy parameters. Methods Using the WHO-recommended PRIME (Papillomavirus Rapid Interface for Modelling and Economics) v2.3 model, we evaluated the cost-effectiveness of HPV vaccination for 13-year-old girls in Guangxi from both healthcare system and societal perspectives. Epidemiological parameters were anchored to 2021, sourced from Guangxi death registration and cancer registry systems, while vaccine prices reflected the latest 2025 government procurement rates. The primary outcome was the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted, with per capita GDP as the willingness-to-pay threshold. Eight vaccine types, 16 age×coverage combinations, and one-way sensitivity analyses were conducted. Results Under the base-case scenario (domestic bivalent HPV vaccine at 27.5 RMB/dose, age 13, 70% coverage), the discounted ICER was − 15,033 RMB/DALY (-0.30× per capita GDP) from the healthcare system perspective, indicating a cost-saving strategy. The benefit-cost ratio was 4.99, meaning each RMB spent on vaccination averts nearly 5 RMB in cervical cancer treatment costs. The domestic 9-valent vaccine (531 RMB/dose) was highly cost-effective (ICER = 25,316 RMB/DALY, 0.50× per capita GDP), and the imported 9-valent vaccine under the 2-dose promotional program (equivalent to 675 RMB/dose) was also well below the cost-effectiveness threshold (ICER = 35,050 RMB/DALY, 0.70× per capita GDP). The societal perspective ICER for the domestic bivalent vaccine was − 14,014 RMB/DALY (-0.28× per capita GDP), remaining economically dominant. One-way sensitivity analyses confirmed that the domestic bivalent vaccination remained cost-saving across all parameter variations. Conclusions Under the 2025 procurement pricing, vaccinating age-eligible girls in Guangxi with the domestic bivalent HPV vaccine is a cost-saving strategy, with every 1 RMB invested averting approximately 5 RMB in direct cervical cancer medical costs. The domestic 9-valent HPV vaccine is also highly cost-effective. Results support accelerating the free HPV vaccination program for age-eligible girls in Guangxi, prioritizing the domestic bivalent vaccine for broad coverage; regions with sufficient fiscal capacity and a pursuit of broader HPV type protection may consider the domestic 9-valent vaccine.</p>