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Abstract Background Catch-up vaccination will be pivotal for achieving WHO’s cervical cancer elimination goals in low-and middle-income countries (LMICs). We assessed the health-economic impact of catch-up HPV vaccination for females in LMICs. Methods Using IARC’s METHIS modelling platform and data from 132 LMICs, we simulated HPV catch-up vaccination beyond the primary target age, varying the maximum age up to 30 years. Budget impact was expressed as a share of national five-year immunization budgets and current health expenditure. We conducted cost-effectiveness analyses for a smaller subset of countries for which high-quality cervical cancer treatment costs were available. Findings Catch-up HPV vaccination up to age 30 in LMICs could prevent 9.2 million cervical cancer cases over the lifetime among females aged 9–30 years. Across countries, budget impact ranged from 0·007%–2·24% of five-year health expenditure and 0·002%–236·65% of immunization budgets, with vaccine procurement comprising about 70% of costs. Gavi support could reduce costs by nearly 70% for catch-up up to age 18. Catch-up vaccination up to age 30 was cost-effective in almost all evaluated countries, except in one where cost-effectiveness was achieved up to age 21. Interpretation In LMICs, after achieving adequate coverage in the primary target group (9–14 years), expanding HPV catch-up vaccination would be impactful and cost-effective. Sustainable financing, Gavi support, and cost-minimization strategies are crucial for successful catch-up programmes and progress toward cervical cancer elimination. Funding This work was supported, in whole or in part, by the Gates Foundation [grant number: INV-039876]. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Gates Foundation. Research in context Evidence before this study Human papillomavirus (HPV) vaccination is central to cervical cancer prevention, and multiple modelling and economic evaluations have assessed its impact in low- and middle-income countries (LMICs). However, most work has focused on vaccinating girls aged 9–14 years, with limited analysis of broader catchup strategies. Although extending vaccination beyond early adolescence can further reduce cervical cancer incidence, evidence on LMIC specific economically feasible age ranges for female HPV catch-up vaccination remains sparse. We searched PubMed for studies up to Jan 13, 2026 using the terms (“human papillomavirus” OR HPV) AND (“papillomavirus vaccines” OR vaccin*) AND (“catchup” OR “catch up”) AND (“cost effectiveness” OR “costeffectiveness” OR economic* OR “budget impact”). We included evaluations of HPV catchup vaccination in LMICs that reported economic outcomes and excluded studies that lacked an economic component. While a few studies in LMICs have conducted cost-effectiveness analyses, suggesting cost-effectiveness of catch-up beyond the primary target age range, we identified no studies that evaluated the budget impact of HPV catch-up vaccination across multiple LMICs. Added value of this study This study provides an integrated assessment of the health and budget impact of HPV catch-up vaccination across 132 LMICs. We also provide cost-effectiveness analyses of incremental extensions of the upper age limit for catch-up vaccination in selected countries with high-quality treatment cost data representing different sexual behaviour clusters. We showed that catch-up HPV vaccination up to age 30 years can reduce the cervical cancer burden by more than 9 million cases in 132 LMICs compared to only routine vaccination of girls aged 9 years. Across countries, budget impact ranged from 0·007%–2·24% of five-year current health expenditure and 0·0016%–236·65% of immunization budgets, with wide variation by country context. Catchup vaccination up to age 30 years was cost-effective in almost all evaluated countries, although in a particular setting cost-effectiveness was achieved up to age 21 years in the base case analysis. Implications of all the available evidence Expanding catch-up HPV vaccination in LMICs would have a clear public health impact and would be value for money but demands careful budgeting. Policymakers should first secure high coverage in the primary target cohort, then set upper age limits and rollout pace according to fiscal space and delivery capacity. Aligning financing and procurement support (e.g., from Gavi) with national resources will be essential for sustainable scale-up.