Cost effectiveness of cervical cancer prevention strategies in Indonesia

Main Article Content

Yusransyah Yusransyah https://orcid.org/0000-0002-2548-5847
Susi Ari Kristina https://orcid.org/0000-0003-4248-6830
Dwi Endarti https://orcid.org/0000-0001-7841-4164

Keywords

IVA test, HPV vaccine, cost effectiveness, cervical cancer

Abstract

Background: The development of several HPV-related control techniques for the prevention of cervical cancer followed the identification of a link between high-risk human papillomavirus (HPV) infection and the occurrence of cervical cancer. Objective: The objective of the current study was to determine how cost-effective the different cervical cancer screening programs and HPV vaccinations in Indonesia. Methods: The lifetime costs and effects of vaccination among adolescent girls or screening with either the VIA, Papanicolaou, or HPV DNA test at various time intervals in a hypothetical cohort of 30-65 yearsold women were estimated using a Markov model based on a societal perspective. Results: Based on statistics on transition probabilities, efficacy of HPV vaccination, and diagnostic accuracy of screening procedures. The findings of this study, specifically the cost-effectiveness of preventing cervical cancer with vaccination, revealed that each woman’s vaccination cost was $16. The amount of disease-adjusted life years (DALYs) that may be saved was $213, and the averted cost per death was $1.438. Conclusion: Early cervical cancer screening using the IVA test method has a net cost of $576 for years of qualityadjusted life saved and costs $18 each examination for each woman, $1,532 for each preventable death. When the group of teenage girls who received the HPV, vaccine reaches the age of 30, the VIA screening frequency should be decided depending on the cohort’s overall HPV vaccination coverage.

Abstract 942 | PDF Downloads 844

References

1. WHO. Cervical Cancer. 2020 [cited 2022 Jul 22]. Available from: https://www.who.int/health-topics/cervical-cancer#tab=tab_1 
2. Wardani RP. A 59 Year Old Woman P 5-5 with Cervical Cancer: Case Report. 2012;951-959.
3. WHO. Cervix uteri Source: Globocan 2020. 2021;419:2020-1. Available from: https://gco.iarc.fr/today/data/factsheets/ cancers/23-Cervix-uteri-fact-sheet.pdf
4. Puji R, As L. Analysis of factors influencing interest in IVF examination at the Tretep Public Health Center, Temanggung Regency, published manuscript. 2017. 
5. The Indonesian Ministry of Health. Indonesia Health Profile 2020. Jakarta: Ministry of Health of the Republic of Indonesia;
2021.
6. Imelda F, Santoso H. Cervical Cancer in Women. First. Medan: Anugrah Pangeran Jaya Press; 2020.
7. Wahidin M, Febrianti R. Overview of Implementing the Human Papillomavirus (HPV) Vaccination Program in Two Health Centers in Central Jakarta City in 2020. 2021;182-191.
8. Andriani Y, Kristina SA, Wiedyaningsih C, et al. Estimation of Direct Medical Costs for Cancer in Indonesia: Estimating Direct Medical Costs (DMC). 2021;17(3):251-255.
9. Sharma VK, Khandpur S. Guidelines for cryotherapy. 2009;75(August):90-100.
10. Ministry of Health of the Republic of Indonesia. Immunization. Jakarta: Indonesian Ministry of Health; 2015. 
11. Campos NG. The comparative and cost-effectiveness of HPV-based cervical cancer screening algorithms in El Salvador. Int J Cancer. 2015;137(4):893-902. https://doi.org/10.1002/ijc.29438  
12. Shi JF. Estimation of the costs of cervical cancer screening, diagnosis and treatment in rural Shanxi Province, China: a microcosting study. BMC Health Serv Res. 2012;12:123. https://doi.org/10.1186/1472-6963-12-123
13. Termrungruanglert W. Cost and effectiveness evaluation of prophylactic HPV vaccine in developing countries. Value Health. 2012;15(1 Suppl):S29-34. https://doi.org/10.1016/j.jval.2011.11.007
14. Goldie SJ. Health and economic outcomes of HPV 16,18 vaccination in 72 GAVI-eligible countries. Vaccine. 2008;26(32):4080- 4093. https://doi.org/10.1016/j.vaccine.2008.04.053
15. Cremer M. Adequacy of visual inspection with acetic acid in women of advancing age. Int J Gynaecol Obstet. 2011;113(1):68- 71. https://doi.org/10.1016/j.ijgo.2010.10.018
16. Organization W.H.O in WHO Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention 2013: Geneva. 2013.
17. World Health Organization Statistical Information System: CHOICE (CHOosing Interventions that are Cost Effective). October 
17, 2021]; Available from: http://www.who.int/choice/en/.
18. Tebeu PM. Effectiveness of a two-stage strategy with HPV testing followed by visual inspection with acetic acid for cervical cancer screening in a low-income setting. Int J Cancer. 2015;136(6):E743-750. https://doi.org/10.1002/ijc.29250
19. Hutubessy R. A case study using the United Republic of Tanzania: costing nationwide HPV vaccine delivery using the WHO Cervical Cancer Prevention and Control Costing Tool. BMC Med. 2012;10(1):136. https://doi.org/10.1186/1741-7015-10-136
20. Jeronimo J. A multicountry evaluation of careHPV testing, visual inspection with acetic acid, and papanicolaou testing for the detection of cervical cancer. Int J Gynecol Cancer. 2014;24(3):576-585. https://doi.org/10.1097/IGC.0000000000000084
21. Kim JJ. Multiparameter calibration of a natural history model of cervical cancer. Am J Epidemiol. 2007;166(2):137-150. https:// doi.org/10.1093/aje/kwm086

Most read articles by the same author(s)