INTRODUCTION: Cervical cancers (CC) demonstrate the second highest incidence of 
female cancers in Malaysia. The costs of chronic management have a high impact 
on nation's health cost and patient's quality of life that can be avoided by 
better screening and HPV vaccination.
METHODOLOGY: Respondents were interviewed from six public Gynecology-Oncology 
hospitals. Methods include experts' panel discussions to estimate treatment 
costs by severity and direct interviews with respondents using costing and SF-36 
quality of life (QOL) questionnaires. Three options were compared i.e. screening 
via Pap smear; quadrivalent HPV Vaccination and combined strategy (screening 
plus vaccination). Scenario based sensitivity analysis using screening 
population coverage (40-80%) and costs of vaccine (RM 300-400/dose) were 
calculated.
RESULTS: 502 cervical pre invasive and invasive cervical cancer (ICC) patients 
participated in the study. Mean age was 53.3 +/- 11.2 years, educated till 
secondary level (39.4%), Malays (44.2%) and married for 27.73 +/- 12.1 years. 
Life expectancy gained from vaccination is 13.04 years and average Quality 
Adjusted Life Years saved (QALYs) is 24.4 in vaccinated vs 6.29 in unvaccinated. 
Cost/QALYs for Pap smear at base case is RM 1,214.96/QALYs and RM 1,100.01 at 
increased screening coverage; for HPV Vaccination base case is at RM 35,346.79 
and RM 46,530.08 when vaccination price is higher. In combined strategy, base 
case is RM 11,289.58; RM 7,712.74 at best case and RM 14,590.37 at worst case 
scenario. Incremental cost-effectiveness ratio (ICER) showed that screening at 
70% coverage or higher is highly cost effective at RM 946.74 per QALYs saved and 
this is followed by combined strategy at RM 35,346.67 per QALYs saved.
CONCLUSION: Vaccination increase life expectancy with better QOL of women when 
cancer can be avoided. Cost effective strategies will include increasing the Pap 
smear coverage to 70% or higher. Since feasibility and long term screening 
adherence is doubtful among Malaysian women, vaccination of young women is a 
more cost effective strategy against cervical cancers.