Cost-Effectiveness, Resource Utilization, and Budget Impact Analysis of HPV Extended Versus Partial Genotyping for Cervical Cancer Screening in Indonesia
Author(s)
Tessa Riandini, PhD, Sahaana Tamilselvan, MPH.
Becton Dickinson Holdings Pte Ltd, Singapore, Singapore.
Becton Dickinson Holdings Pte Ltd, Singapore, Singapore.
OBJECTIVES: Cervical cancer screening is a multifaceted challenge that requires new strategies such as HPV DNA test using extended genotyping (XGT). XGT reports individual results for 14 higher-risk genotypes, allowing for risk stratification based on carcinogenicity, whereas partial genotyping (PGT) only reports individual results for HPV16/18. Previous studies have evaluated the cost-effectiveness of XGT compared to PGT in primary HPV testing with cytology triage. However, in countries without cytology capacity, visual inspection with acetic acid (VIA) is the preferred triage method. This study evaluates patient outcomes and economic impact of adopting XGT compared to PGT in the context of primary HPV testing with VIA triage.
METHODS: A multi-state Markov model was developed to compare XGT with PGT as HPV primary screening with VIA triage. 1,000,000 women between 30-59 years was simulated over 20 years in six health states: no HPV, HPV infection, precancer, cancer stage 1, cancer stages 2-4, and dead. HPV infections were categorized into five risk groups according to WHO latest guideline. Costs and HPV prevalence inputs were obtained from published studies in Indonesia, including peer-reviewed literature and health technology assessment report. Outcomes evaluated included incremental cost-effectiveness ratio (ICER), precancer and cancer cases, and resource utilization.
RESULTS: Compared to PGT, XGT was dominant with estimated cost savings of USD 1,601 per QALY over a 20-year period. XGT resulted in 2.5% more screenings and averted 11.7% precancer and 3.1% cancer cases. Adopting XGT also resulted in reduced number of VIAs and referrals by 26%, amounting to a total of 3.1% cost savings per 1,000,000 women over 20 years.
CONCLUSIONS: Cervical cancer screening with HPV XGT could result in potential cost savings to the healthcare system through more efficient clinical management which focuses resources on high-risk patients. This could facilitate national screening programs to achieve better outcomes and aid in cervical cancer elimination efforts.
METHODS: A multi-state Markov model was developed to compare XGT with PGT as HPV primary screening with VIA triage. 1,000,000 women between 30-59 years was simulated over 20 years in six health states: no HPV, HPV infection, precancer, cancer stage 1, cancer stages 2-4, and dead. HPV infections were categorized into five risk groups according to WHO latest guideline. Costs and HPV prevalence inputs were obtained from published studies in Indonesia, including peer-reviewed literature and health technology assessment report. Outcomes evaluated included incremental cost-effectiveness ratio (ICER), precancer and cancer cases, and resource utilization.
RESULTS: Compared to PGT, XGT was dominant with estimated cost savings of USD 1,601 per QALY over a 20-year period. XGT resulted in 2.5% more screenings and averted 11.7% precancer and 3.1% cancer cases. Adopting XGT also resulted in reduced number of VIAs and referrals by 26%, amounting to a total of 3.1% cost savings per 1,000,000 women over 20 years.
CONCLUSIONS: Cervical cancer screening with HPV XGT could result in potential cost savings to the healthcare system through more efficient clinical management which focuses resources on high-risk patients. This could facilitate national screening programs to achieve better outcomes and aid in cervical cancer elimination efforts.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD287
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology