Cost Utility Analysis of Human Papillomavirus Vaccination and Cervical Screening on Cervical Cancer Patient in Indonesia

Didik, Setiawan (2018) Cost Utility Analysis of Human Papillomavirus Vaccination and Cervical Screening on Cervical Cancer Patient in Indonesia. ARTIKEL JURNAL.

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Abstract

Background Although cervical cancer is a preventable disease, the clinical and economic burdens of cervical cancer (worldwidescience.org) are still substantial issues in Indonesia. Methods We developed a population-based Markov Model, consisting of three health states (susceptible, cervical cancer and death) to assess future costs, health effects and the cost-utility of cervical cancer (worldwidescience.org) prevention strategies in Indonesia. We followed a cohort of 100,000 women from 12 to 100 years old and compared Visual Inspection with Acetic acid (VIA) screening (worldwidescience.org) alone with the addition of Human Papillomavirus (HPV) vaccination on (orwh.od.nih.gov) top of the screening to no intervention. Results The implementation of VIA screening alone and in combination with HPV vaccination would reduce the cervical cancer incidence (orwh.od.nih.gov) by 7.9% and 58,5%, corresponding to 25 and 98 deaths avoided within the cohort of 100,000, respectively. We also estimated that HPV vaccination combined with VIA screening apparently yielded a lower incremental cost-effectiveness ratio (ICER) at I$1,863/QALYs, compared to VIA screening alone (I$3,126/QALYs). Both strategies could however be definitely labeled as very cost-effective interventions, based on a threshold suggested by the World Health Organization. The ICER was sensitive to the discount rate, cervical cancer treatment costs and quality of life as part of the QALY. Conclusion The addition of HPV vaccination on top of VIA screening could be a cost-effective strategy in Indonesia even if relatively conservative assumptions are applied. This population-based model can be considered as an essential tool to inform decision makers on designing optimal strategies for cervical cancer (www.science.gov) prevention in Indonesia.

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