Cervical cancer prevention in Indonesia: An updated clinical impact, cost-effectiveness and budget impact analysis

Abstract

Introduction The clinical and economic impact of cervical cancer consistently become a serious burden for all countries, including Indonesia. The implementation of HPV vaccination policy for a big country such as Indonesia requires a strong commitment from several decision-makers. The aim of this study was to provide a comprehensive description on cost-effectiveness and the budget-impact of HPV vaccination policy in Indonesia. Method A cohort Markov model was used to evaluate the cost and the clinical impact of HPV vaccination for 10 years old girls in Indonesia. The researchers consider two doses of all three available HPV vaccines adjusted with the HPV infection profilewith 95% vaccination coverage to estimate the national cervical cancer incidence and mortality. The Budget impact analysis explores three different scenarios covering (1) Two districts per year expansion, (2) oneprovince per year expansion and (3) achieving the National Immunization Program in 2024. Results Upon fully vaccinating almost 2.3 million 10-year-old girls, 34,723; 43,414; and 51,522 cervical cancer cases were prevented by Quadrivalent, Bivalent and Nonavalent vaccines, consecutively. Furthermore, the highest (591 cases) and lowest (399 cases) mortality were prevented by Nonavalent and Quadrivalent vaccines, respectively. Most of the vaccines were considerably cost-effective and only the Bivalent vaccine with the GAVI/UNICEF price which will be considered a cost-saving strategy.To provide national coverage of HPV vaccination in Indonesia, the government has to provide an annual budget of about US$49 million

Knowledge, attitudes, and practices among Indonesian urban communities regarding HPV infection, cervical cancer, and HPV vaccination

“…A study showed that HPV vaccination is not cost-effective when the price is above 50 USD per dose, especially for people living in rural areas [ 99 ]. In addition, Indonesia’s self-financing of HPV vaccination policy demands a massive allocation since the country has to supply about five million (two doses x 2.5 million 10-year girls) doses annually [ 100 ]. Furthermore, the vaccination cost must consider the vaccine price, shipping, insurance, and handling fees (i.e., customs clearance, warehouse storage, transportation, and labeling), creating more costly [ 100 ].…”

Construção e validação de jogo educativo sobre a infecção pelo papilomavírus humano

“…Assim, esse jogo pode contribuir para o aumento da taxa de adesão à vacinação, considerada baixa no estudo mencionado. A vacinação mostrou-se uma estratégia econômica e acessível, (32) portanto, deve ser estimulada. Estudo (11) demonstrou que o desconhecimento sobre o HPV e sua vacinação leva à relutância dos pais em vacinar seus filhos, enquanto a percepção de risco pela infecção do HPV associou-se positivamente a adesão a vacinação.…”

Multi-criteria decision analysis to prioritize the introduction of new vaccines in Indonesia by using the framework of the strategic multi-attribute ranking tool for vaccines (SMART vaccines)

“…Applying country-specific data in relation to 30 pre-defined available attributes [13][14][15][16][17][18][19][20][21][22][23][24][25], we found that only 10 attributes gave different impact on prioritizing new vaccines since they had significant difference values among four new vaccines. These attributes are: (i) premature deaths averted per year, (ii) incident cases prevented per year, (iii) quality-adjusted life years (QALYs) gained or disabilityadjusted life years (DALYs) averted, (iv) net direct costs (savings) of vaccine use per year, (v) workforce productivity gained per year, (vi) cost-effectiveness, (vii) benefits for infants and children, (viii) benefits for women, (ix) availability of existing or adaptable manufacture techniques, and (x) interest from NGOs and philanthropic organizations.…”