OBJECTIVES: To estimate the impact of strategies for cervical cancer prevention and control in Indonesia.

METHODS: An excel-based Markov model was used to simulate the effectivity of strategies for cervical cancer prevention and control in term of epidemiologic output which were incidence and mortality of cervical cancer diseases. The strategies included 17 scenarios which varied in combinations of intervention and interval for screenings. Model structure and probabilities were adopted from previous studies conducted in many other settings. Model was validated by comparing the model output versus observed data of cervical cancer in Indonesia including HPV prevalence, cervical cancer incidence and mortality, and distribution of cancer by state of cancer. Validation process employed qualitative approach using visual technique and quantitative approach using deviation value. Model calibration was conducted using “trial and error” to get model probabilities that resulted valid output.

RESULTS: Based on valid model output, strategies of HPV vaccination resulted highest reduction of cervical cancer incidence and mortality, and followed by strategy of screening with Pap smear and VIA. Combination of strategies, shorter screening interval, and larger vaccination coverage rate would increase effectivity of strategy. Single strategy of HPV vaccination, screening with Pap smear, and screening with VIA yielded reduction of cervical cancer incidence by 36%, 12 – 17%, and 9 – 13%, respectively. Moreover they yielded reduction of cervical cancer mortality by 31%, 6 – 13%, and 2 – 7%, respectively. Strategy of HPV vaccination combined with VIA every 3 years for woman aged 30 – 45 years old and followed by Pap smear every 3 years for woman aged 48 – 63 years old was the most effective strategy.

CONCLUSIONS:

This model could then be used to estimate the lifetime costs and outcomes for cost effectiveness analysis of strategies for cervical cancer prevention and control in Indonesia.