Cost-Utility Analysis of Human Papillomavirus Vaccination and Cervical Screening on Cervical Cancer Patient in Indonesia

Setiawan, D., Dolk, F. C., Suwantika, A. A., Westra, T. A., WIlschut, J. C. & Postma, M. J., 1-May-2016, In : Value in Health Regional Issues. 9, p. 84-92 9 p.

Research output: Contribution to journalArticleAcademicpeer-review

Copy link to clipboard


  • Cost-Utility Analysis of Human Papillomavirus Vaccination

    Final publisher's version, 708 KB, PDF document

    Request copy


BACKGROUND: Although cervical cancer is a preventable disease, the clinical and economic burdens of cervical cancer are still substantial issues in Indonesia.

OBJECTIVES: The main purpose of this study was to model the costs, clinical benefits, and cost-utility of both visual inspection with acetic acid (VIA) screening alone and human papillomavirus (HPV) vaccination in addition to VIA screening in Indonesia.

METHODS: We developed a population-based Markov model, consisting of three health states (susceptible, cervical cancer, and death), to assess future costs, health effects, and the cost-utility of cervical cancer prevention strategies in Indonesia. We followed a cohort of 100,000 females 12 to 100 years old and compared VIA screening alone with the addition of HPV vaccination on top of the screening to "no intervention."

RESULTS: The implementation of VIA screening alone and in combination with HPV vaccination would reduce the cervical cancer incidence by 7.9% and 58.5%, corresponding to 25 and 98 deaths avoided within the cohort of 100,000, respectively. We also estimated that HPV vaccination combined with VIA screening apparently yielded a lower incremental cost-effectiveness ratio at international dollar 1863/quality-adjusted life-year (QALY), compared with VIA screening alone (I$3126/QALY). Both strategies could however be definitely labeled as very cost-effective interventions, based on a threshold suggested by the World Health Organization. The incremental cost-effectiveness ratio was sensitive to the discount rate, cervical cancer treatment costs, and quality of life as part of the QALY.

CONCLUSIONS: The addition of HPV vaccination on top of VIA screening could be a cost-effective strategy in Indonesia even if relatively conservative assumptions are applied. This population-based model can be considered as an essential tool to inform decision makers on designing optimal strategies for cervical cancer prevention in Indonesia.

Original languageEnglish
Pages (from-to)84-92
Number of pages9
JournalValue in Health Regional Issues
Publication statusPublished - 1-May-2016


  • Cervical cancer, Cost-utility analysis, Human papillomavirus, Indonesia, Vaccination, Wart virus vaccine, adult, article, cancer incidence, cancer screening, cause of death, cohort analysis, controlled study, cost effectiveness analysis, cost utility analysis, decision making, drug efficacy, female, human, major clinical study, priority journal, quality adjusted life year, uterine cervix cancer, vaccination, world health organization

ID: 29252790