Cost utility Analysis of Expanding Human Papillomavirus Vaccination Program for Boys in Indonesia Using Markov Model

Ditya Tiwi Syafira, Dr. apt. Dwi Endarti, M.Sc.

2024 | Tesis | Magister Manajemen Farmasi

Background: The high rate of cancer caused by the Human papillomavirus (HPV) affects the economic level of people in Indonesia. They must pay for treatment and maintain quality of life. HPV virus is proven to be a cause of cervical and non-cervical cancer, such as head and neck cancer and anogenital cancer. The HPV vaccine has been introduced to prevent HPV-related cancers cervical. Objective: This study aims to determine how cost-effective the expanding HPV vaccination program for boys in Indonesia is to prevent HPV-related cancers. Method: This study used pharmacoeconomic analysis based on cost utility analysis (CUA). Cost and utility outcomes were simulated using Markov model compared in girls’ population and both (girls and boys) population who were given HPV vaccination with no vaccination to prevent HPV-related cancers in Indonesia. The model developed based on cohort simulation in 100.000 girls aged 11 years old, and included boys with the same age according to WHO rules regarding receiving two doses of the HPV vaccine using Microsoft Excel with three health stages (susceptible, HPV-related cancers, and death). Model developed reflects a lifetime with annual cycles and 3% discount rate. We performed our analysis from the payer (BPJS, INA-CBG’s tariff) perspective into 2 scenarios: HPV vaccination program in girls only and expanding vaccination for including boys. Result: The prevention of cervical cancer for girls through HPV vaccination was highly cost-effective (-Rp16.246.719/ QALY in cervical cancer prevention and Rp42.305.582/ QALY for HPV-related cancers prevention). The expansion of HPV vaccination to boys has been shown to be cost-effective. The cost-effectiveness ratios were Rp120,945/QALY compared to unvaccinated girls and boys, Rp1,234,012/QALY compared to girls-only vaccination in preventing cervical cancer, and Rp38,766/QALY compared to girls-only vaccination in preventing HPV-related cancers. The HPV vaccine has proven effective in reducing the incidence of HPV-related cancers, benefiting both girls (aligned with the initial vaccination program goal) and boys who are not immune to HPV infection. The vaccination of both girls and boys resulted in 38.97% reduction in incidence, while vaccinating only girls resulted in 37.69%. Conclusion: It is advisable to provide recommendations to the government to consider expanding the HPV vaccination program to include boys, thereby extending its benefits more broadly.

Background: The high rate of cancer caused by the Human papillomavirus (HPV) affects the economic level of people in Indonesia. They must pay for treatment and maintain quality of life. HPV virus is proven to be a cause of cervical and non-cervical cancer, such as head and neck cancer and anogenital cancer. The HPV vaccine has been introduced to prevent HPV-related cancers cervical. Objective: This study aims to determine how cost-effective the expanding HPV vaccination program for boys in Indonesia is to prevent HPV-related cancers. Method: This study used pharmacoeconomic analysis based on cost utility analysis (CUA). Cost and utility outcomes were simulated using Markov model compared in girls’ population and both (girls and boys) population who were given HPV vaccination with no vaccination to prevent HPV-related cancers in Indonesia. The model developed based on cohort simulation in 100.000 girls aged 11 years old, and included boys with the same age according to WHO rules regarding receiving two doses of the HPV vaccine using Microsoft Excel with three health stages (susceptible, HPV-related cancers, and death). Model developed reflects a lifetime with annual cycles and 3% discount rate. We performed our analysis from the payer (BPJS, INA-CBG’s tariff) perspective into 2 scenarios: HPV vaccination program in girls only and expanding vaccination for including boys. Result: The prevention of cervical cancer for girls through HPV vaccination was highly cost-effective (-Rp16.246.719/ QALY in cervical cancer prevention and Rp42.305.582/ QALY for HPV-related cancers prevention). The expansion of HPV vaccination to boys has been shown to be cost-effective. The cost-effectiveness ratios were Rp120,945/QALY compared to unvaccinated girls and boys, Rp1,234,012/QALY compared to girls-only vaccination in preventing cervical cancer, and Rp38,766/QALY compared to girls-only vaccination in preventing HPV-related cancers. The HPV vaccine has proven effective in reducing the incidence of HPV-related cancers, benefiting both girls (aligned with the initial vaccination program goal) and boys who are not immune to HPV infection. The vaccination of both girls and boys resulted in 38.97% reduction in incidence, while vaccinating only girls resulted in 37.69%. Conclusion: It is advisable to provide recommendations to the government to consider expanding the HPV vaccination program to include boys, thereby extending its benefits more broadly.

Kata Kunci : CUA, Markov model, HPV-related cancers, HPV vaccination, Boys.