OBJECTIVES: This study aimed to evaluate the health and economic benefits of strategies for cervical cancer prevention and control in Indonesia using cost utility analysis approach.

METHODS: A Markov model was adopted to simulate an age-stratified cohort of women in Indonesia. Seventeen strategies consisted of single or combination strategies of human papillomavirus (HPV) vaccination, screening with visual acetic acid (VIA), and screening with Pap smear were analyzed and compared with existing strategy of treatment for cervical cancer or “do nothing” strategy. The strategies and scenarios varied in combinations of intervention and interval for screenings, coverage of screening and vaccination, and vaccine doses.

RESULTS: At base case, all screening strategies had incremental cost effectiveness ratios (ICERs) less than per capita GDP of Indonesia in 2013 (IDR 35 million or USD 3,475). The most cost effective strategy with the lowest ICER was screening with VIA every 5 years, which the incremental cost effectiveness ratios (ICERs) were IDR -204,000 (USD -19.77) per quality adjusted life year (QALY), a cost saving strategy in a societal perspective; and IDR 634,000 (USD 61.45) per QALY, in a health system’s perspective. All strategies involving vaccination had ICERs between 1 – 3 times GDP. The ICER for providing HPV vaccination as single intervention revealed from this study were IDR 77.6 million (USD 7,522) per QALY and IDR 46.3 million (USD 4,490) per QALY for 3 and 2 doses assumptions, respectively, in a societal perspective. Meanwhile, in a health system’s perspective, ICER for vaccinations were IDR 77.8 million (USD 7,541) per QALY and IDR 48.4 million (USD 4,689) per QALY for 3 and 2 vaccine dose strategies, respectively.

CONCLUSIONS:

Economic evidence resulted from this pharmacoeconomic analysis support a continuation of VIA program in Indonesia, recommendation of scaling up the screening program for the whole country, and consideration of HPV vaccination implementation.