Didik Setiawan

HPV Vaccination Program in Indonesia: Effectiveness, Dose, Scale-Up Costs, Future Prospects, and Policy Recommendations

Among females, Cervical cancer affects more frequently than any other type of cancer in Indonesia. Cervical cancer and illnesses linked to HPV infection are potentially preventable through vaccination.  The aim of his study was to describe the characteristics of the available vaccines, the  policy, and the implementation of HPV vaccination in Indonesia. A scoping review was performed by collecting information from previous studies, including general information about vaccines, vaccine efficacy, effectiveness, and safety. Approved HPV vaccine products in Indonesia have proven efficacy, effectiveness, and safety. Procuring vaccines through GAVI/UNICEF and the government has both advantages and disadvantages. Alongside the limited supply, numerous research studies show that dosage reduction to a single dose provides equal protection compared to 2-3 doses. The benchmark implementation of the single dose has been done in many countries, ranging from high-income to low-middle-income countries. Therefore, considering other countries and Indonesia's high population and vaccination burden, proposed updates for vaccination programs are recommended to achieve the cancer elimination target by 2030. Improvement of vaccination programs using single-dose HPV vaccine to prevent cervical cancer requires a coherent framework, sufficient funds, effective management of stakeholder interests, and sensitivity to contextual factors.

Toward a Framework to Assess the Financial and Economic Burden of Cervical Cancer in Low- and Middle-Income Countries: A Systematic Review

PURPOSE To review the economic burden assessment of cervical cancer in low- and middle-income countries (LMICs) and use the findings to develop a pragmatic, standardized framework for such assessment. METHODS We first systematically reviewed articles indexed in scientific databases reporting the methodology for collecting and calculating costs related to the cervical cancer burden in LMICs. Data on study design, costing approach, cost perspective, costing period, and cost type (direct medical costs [DMC], direct nonmedical costs [DNMC], and indirect costs [IC]) were extracted. Finally, we summarized the reported limitations in the methodology and used the solutions to inform our framework. RESULTS Cervical cancer treatment costs across LMICs vary greatly and can be extremely expensive, up to 70,968 International US dollars. Economic and financial assessment methods also vary greatly across countries. Of the 28 reviewed articles, 25 studies reported DMC for cervical cancer treatment by extracting cost information from billing or insurance databases (eight studies), conducting surveys (five), and estimating the costs (12). Only 11 studies—mainly through surveys—reported DNMC and IC. The economic burden assessment framework includes health care/payer and societal perspectives (DMC, DNMC, IC, and human capital loss) across the cervical cancer screening and treatment continuum. To assess health care/payer costs, we recommend combining the predefined treatment standards with actual local treatment practices, multiplied by unit costs. To assess societal costs, we recommend conducting a cost survey in line with a standardized yet adaptable protocol. CONCLUSION Our standardized, pragmatic framework allows assessment of economic and financial burden of cervical cancer in LMICs despite the different levels of available resources across countries. This framework will facilitate global comparisons and monitoring and may also be applied to other cancers.

Cervical cancer prevention in Indonesia: An updated clinical impact, cost-effectiveness and budget impact analysis

The clinical and economic impact of cervical cancer consistently become a serious burden for all countries, including Indonesia. The implementation of HPV vaccination policy for a big country such as Indonesia requires a strong commitment from several decision-makers. The aim of this study was to provide a comprehensive description on cost-effectiveness and the budget-impact of HPV vaccination policy in Indonesia. A cohort Markov model was used to evaluate the cost and the clinical impact of HPV vaccination for 10 years old girls in Indonesia. The researchers consider two doses of all three available HPV vaccines adjusted with the HPV infection profilewith 95% vaccination coverage to estimate the national cervical cancer incidence and mortality. The Budget impact analysis explores three different scenarios covering (1) Two districts per year expansion, (2) oneprovince per year expansion and (3) achieving the National Immunization Program in 2024. Upon fully vaccinating almost 2.3 million 10-year-old girls, 34,723; 43,414; and 51,522 cervical cancer cases were prevented by Quadrivalent, Bivalent and Nonavalent vaccines, consecutively. Furthermore, the highest (591 cases) and lowest (399 cases) mortality were prevented by Nonavalent and Quadrivalent vaccines, respectively. Most of the vaccines were considerably cost-effective and only the Bivalent vaccine with the GAVI/UNICEF price which will be considered a cost-saving strategy.To provide national coverage of HPV vaccination in Indonesia, the government has to provide an annual budget of about US$49 million and US$22 million using the government contract price and GAVI/UNICEF price, respectively. HPV vaccination shows a cost-effective strategy and the budget required to provide this policy is considerably affordable for Indonesia.

The willingness for cervical cancer screening among sexually active women in Indonesia: Lesson learned from two districts

AbstractObjectiveTo determine the factors that affect women’s willingness at childbearing age to detect/screen for cervical cancer.MethodsA cross‐sectional study was carried out on sexually active women, aged 30–50 years residing in Banyumas and Gunung Kidul Districts, Indonesia. There were 600 respondents. This study focused on the impact of knowledge, access to health information, and support of their husband on the willingness to undergo early detection of cervical cancer.ResultsThis study revealed that there was a statistically significant difference (P = 0.000) between the women who were willing and unwilling to do the screening in terms of higher knowledge (64.67% and 36.21%), obtained access to the information (80.43% and 54.74%), and supported by their husband (63.59% and 29.31%). This study also discovered that the willingness to be screened was significantly affected by spousal support (odds ratio [OR] 4.19, 95% confidence interval [CI] 2.81–6.27). Other factors, such as education level (OR 2.94, 95% CI 1.20–6.63), knowledge (OR 2.29, 95% CI 1.52–3.44), and access to information (OR 2.08, 95% CI 1.34–3.24), were also important drivers.ConclusionTo improve the coverage of cervical screening, several aspects could be treated, including education, knowledge, access to information, and spousal support.