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A new frontier of cervical cancer prevention began with use of human papillomavirus (HPV) vaccines, but the question is: which vaccine to choose? There are now two highly efficacious vaccines approved in many developed countries, the Merck quadrivalent HPV 6/11/16/18 (Gardisil) and the GSK bivalent HPV 16/18 (Cevarix). Many countries have committed to HPV immunisation programmes, and most of them, like the USA, published recommendations before the approval of the bivalent vaccine.1 2 The UK has now chosen the bivalent product in contrast to the rest of Europe that has gone with the quadivalent product, although this decision has led to criticism.3 4 Presumably the decision would be based on the economic consequences, since this is the major determinant for policymakers. Vaccine cost played a significant role in the initial rejection to add HPV vaccine to the formulary of the Australian National Immunization Program under the recommendation of the Pharmaceutical Benefits Advisory Committee, although this was soon overturned, resulting in a successfully launched national vaccination programme.1 5 The Irish HPV immunisation plan was interrupted due to the outright cost of any HPV vaccination programme, even though HPV 16/18 vaccination showed a favourable cost-effectiveness compared with other countries.6 …
Competing interests: None.