Abstract
BackgroundCervical cancer poses a substantial burden in terms of morbidity, mortality, and economic losses, especially in low/middle-income countries. HPV vaccination and/or cervical cancer screening among females may reduce the burden of HPV-related diseases, including cervical cancer. However, limited funds may impede the implementation of population-based programmes. Governmental investments in the prevention of infectious disease may have broader economic and fiscal benefits, which are not accounted in conventional economic analyses. This study estimates the broader economic and fiscal impacts of implementing HPV vaccination and/or cervical cancer screening in Indonesia from the perspective of the government.MethodsA government-perspective quantitative analytic framework was applied to assess the Net Present Value (NPV) of investment on cervical cancer prevention strategies including HPV vaccination, cervical screening and its combination in Indonesia. All monetary values were presented in International Dollars (I$).ResultsBased on a cohort of 10,000,000 Indonesian 12-year-old females, it was estimated that HPV vaccination and/or cervical cancer screening result in a positive NPV for the Indonesian government. The combination of cervical screening and HPV vaccination generated a substantial reduction of cervical cancer incidence and HPV-related mortality of 87,862 and 19,359, respectively. It was estimated that HPV vaccination in combination with cervical screening is the most favorable option for cervical cancer prevention (NPV I$2.031.786.000), followed by HPV vaccination alone (NPV I$1.860.783.000) and cervical screening alone (NPV I$375.244.000).ConclusionIn addition to clinical benefits, investing in HPV vaccination and cervical screening may yield considerable fiscal benefits for the Indonesian governments due to lifelong benefits resulting from reduction of cervical cancer-related morbidity and mortality.
Highlights
High-risk human papillomaviruses, in particular HPV16 and HPV18, are responsible for cervical cancer and premalignant cervical disease among woman [1,2,3,4,5]
Based on a cohort of 10,000,000 Indonesian 12-year-old females, it was estimated that HPV vaccination and/or cervical cancer screening result in a positive Net Present Value (NPV) for the Indonesian government
The combination of cervical screening and HPV vaccination generated a substantial reduction of cervical cancer incidence and HPV-related mortality of 87,862 and PLOS ONE | DOI:10.1371/journal.pone
Summary
High-risk human papillomaviruses (hrHPV), in particular HPV16 and HPV18, are responsible for cervical cancer and premalignant cervical disease among woman [1,2,3,4,5]. Several health-economic analyses have shown that HPV vaccination combined with cervical cancer screening results in an efficient use of healthcare resources [16,17,18,19]. Such analyses typically assess the cost-effectiveness of adding HPV vaccination to screening. Implementation of vaccination and cervical cancer screening programmes is dependent on affordability and local infrastructure especially in low/middle-income countries, which have limited infrastructure, human resources and funds. In low/middle-income countries, implementation of population-based HPV vaccination and screening programmes, such as VIA screening which is suitable for low/middle-income countries, may require funds additional to the healthcare budget. This study estimates the broader economic and fiscal impacts of implementing HPV vaccination and/or cervical cancer screening in Indonesia from the perspective of the government
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