{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:51:06Z","timestamp":1781805066396,"version":"3.54.5"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical cancer imposes a disproportionate burden in low- and middle-income countries (LMICs), where second-dose dropout substantially limits the real-world effectiveness of two-dose HPV vaccination programmes. Single-dose schedules eliminate dropout but provide shorter-duration protection. Whether single-dose vaccination is economically preferred to two-dose vaccination, and under what conditions the two strategies yield divergent recommendations depending on the health outcome metric used, has received limited attention in published cost-effectiveness analyses, particularly for the direct head-to-head schedule comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a static Markov cohort model, assessed for face validity against observed incidence data, tracking 100,000 girls aged 9\u202fyears through a lifetime horizon (to age 99) within an LMIC composite derived from Kenya (low-income) and India (lower-middle-income). Three strategies were compared: no vaccination (reference), 1-dose HPV vaccination (efficacy 87% against HPV 16\/18-attributable CIN2+; 20-year base-case protection duration), and 2-dose vaccination (efficacy 93%; lifetime protection). Programme coverage was 49% for both strategies; a 15% second-dose dropout rate reduced 2-dose effective coverage to 41.7%. Costs (2024 USD), disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were estimated from a healthcare payer perspective with 3% annual discounting, within a static direct-effect framework that does not capture herd immunity. Willingness-to-pay thresholds of USD 200\/DALY (low-income) and USD 500\/DALY (lower-middle-income) were applied from Disease Control Priorities, 3rd edition. Uncertainty was characterised through 10,000-simulation probabilistic sensitivity analysis (PSA) and pre-specified scenario analyses examining second-dose dropout rates from 5 to 45% and 1-dose protection durations of 10\u202fyears, 20\u202fyears (base-case), and lifetime.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both strategies were dominant (cost-saving and more effective) versus no vaccination. Per 100,000 girls, 1-dose prevented 64 invasive cervical cancer (ICC) cases and 77 deaths, averting 5,545 DALYs with a net cost saving of USD 1,233,242 (ICER: \u2212USD 222\/DALY). Two-dose prevented more cases (87) and deaths (95) but, under the base-case 20-year protection assumption, averted fewer DALYs (5,149) and saved less (USD 980,690). This divergence reflects the age-concentration of 1-dose protection in women aged 15\u201329\u202fyears (86.4 DALYs per averted case vs. 59.2 for 2-dose) and is structurally dependent on the 20-year protection duration assumption; at lifetime protection, this DALY efficiency difference diminishes. In PSA, 1-dose was dominant in 99.3% of simulations (mean ICER: \u2212USD 195\/DALY; 95% credible interval [CrI]: \u2212USD 315 to \u2212USD 64) and cost-effective at both thresholds in 100% of simulations. Two-dose was dominant in 91.8% of simulations (mean ICER: \u2212USD 133\/DALY; 95% CrI: \u2212USD 284 to +USD 136). The 1-dose ICER was invariant to second-dose dropout rate; the 2-dose ICER deteriorated from \u2212USD 141\/DALY at 5% dropout to \u2212USD 105\/DALY at 45% dropout.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The finding that the single-dose strategy achieves greater DALY efficiency per dollar is structurally dependent on the base-case assumption of 20-year single-dose protection duration and should not be interpreted as a general empirical finding. Under this specific assumption, elimination of second-dose dropout raised effective coverage from 41.7 to 49.0% and concentrated protection in women aged 15\u201329 where each averted case contributes more years of life lost. Sensitivity analyses show this DALY efficiency advantage narrows or reverses if single-dose protection is shorter (10\u202fyears) or extends to lifetime. Across all scenarios examined, the two-dose strategy prevented more absolute cancer cases and deaths than single-dose. These are scenario-specific, exploratory findings generated within a Kenya\u2013India composite under a static direct-effect framework; national programme decisions should incorporate country-specific dropout rates, emerging long-term evidence on single-dose protection duration, locally applicable outcome metrics, and country-calibrated modelling before drawing policy conclusions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1833764","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:40:50Z","timestamp":1780551650000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of single-dose versus two-dose HPV vaccination: a Markov cohort modelling analysis of a Kenya\u2013India LMIC composite"],"prefix":"10.3389","volume":"14","author":[{"given":"Jinyao","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine, YunCheng Vocational Nursing College","place":["YunCheng, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Basic Medicine, Luohe Medical College","place":["Luohe, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Surgery, Shanxi Provincial People\u2019s Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuxiang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency, Shanxi Provincial Children\u2019s Hospital","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"ref2","volume-title":"Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem","year":"2020"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1056\/EVIDoa2100056","article-title":"Efficacy of single-dose HPV vaccination among young African women","volume":"1","author":"Barnabas","year":"2022","journal-title":"NEJM Evid"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"4774","DOI":"10.1016\/j.vaccine.2017.12.078","article-title":"Evidence for single-dose protection by the 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