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Objective: To review the recommendations on Human Papillomavirus (HPV) vaccination issued by different medical societies, as well as disclosures of any conflict of interests regarding such recommendations., Methods: The search for recommendations was mainly conducted through the Internet, together with a bibliography search on Pubmed (November 2008). The countries were selected to encompass a broad range of healthcare systems and income levels., Results: In all, 18 documents were identified: 4 from the U.S., 5 from Canada, and 1 from France (all 10 in favor of recommending vaccination), 5 from Spain (3 in favor of vaccination and 2 recommending no vaccination until further evidence of the vaccine effectiveness to prevent cervical cancer becomes available), 2 from Argentina (one in favor of vaccination and another pointing to the missing information on the vaccine's cost-effectiveness), and 1 from Chile (recommending no vaccination until more information becomes available). Only two documents disclose specific conflicts of interests for authors (American Cancer Society and Chilean Working Group on HPV). One of the Canadian documents did not include any conflict of interest statement, although Merck and GSK are listed among the sponsors., Conclusions: Disclosure of conflicts of interest in documents where medical societies issue recommendations on HPV vaccination is very unusual. However, lack of disclosure is more frequent (near twice) when recommendations are in favor of the vaccination.

Objective: We describe the heterogeneity of the estimates of the incremental cost per quality-adjusted year of life (QALY) within and between cost-utility studies of the human papillomavirus (HPV) vaccine., Method: We searched for articles in English published in peer-reviewed journals that perform cost-utility analyses to evaluate the addition of HPV vaccine to 12-year-old girls to existing cervical cancer screening practices. Fifteen studies were selected according to our inclusion and exclusion criteria., Results: There are large within-study variations in estimates of the cost per QALY gained. The most influential source of uncertainty is the duration of the vaccine protection. Between-study variations are mainly due to three causes: methodological differences, assumptions, and local conditions in the application area. We find large variations between studies for a given country., Discussion: Economic evaluation models are increasingly sophisticated, but scientific treatment of epidemiological and market uncertainty does not compensate for the lack of basic information., Conclusions: The large disparities in cost per QALY estimates of massive vaccination programs around the world may be attributed to several critical sources (unavoidable and avoidable) of uncertainty. An asset of economic evaluation is the ability to highlight the areas of research that could be undertaken to reduce uncertainty.