Cost-Utility Analysis of Expanding Human Papillomavirus Vaccination to Adult Women in Indonesia: A Markov Model Approach

Objectives: Human papillomavirus (HPV) infection is not only associated with cervical cancer but also with anogenital cancers and head and neck cancers. Cancers related to HPV contribute not only to high rates of morbidity and mortality but also impose significant healthcare costs. Methods: A population-based Markov model for HPV-related cancers in Indonesia was developed using Microsoft Excel. We hypothesized a cohort of 100,000 population of girls and 100,000 population of adult women starting from 11 years old and followed until 74 years old based on 2 strategies. HPV vaccination of girls (current situation) as a base case and HPV vaccination of girls and adult women as a new proposed intervention. One-way and probabilistic sensitivity analyses were carried out to address the uncertainty in this study. Results: Including adult women in HPV vaccination for preventing HPV-related cancers results in an incremental cost-effectiveness ratio of IDR �747,610/quality-adjusted life years. This indicated that including adult women alongside girls in preventing HPV-related cancers through HPV vaccination is cost saving. HPV vaccination is capable of reducing the incidence of HPV-related cancers in both girls and women. The number of HPV-related cancer cases that can be prevented in the intervention group compared with the base case is 2274 new cases per 100,000 population. Conclusions: Our study demonstrates that adding adult women to the existing vaccination program (HPV vaccination in girls) in Indonesia is a cost-saving strategy for preventing HPV-related cancers. We recommend the implementation of a vaccination program for adult women could be included as a requirement for marriage for prospective brides.