Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Department of Radiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Asian Pac J Cancer Prev. 2024 Sep 1;25(9):3015-3022. doi: 10.31557/APJCP.2024.25.9.3015.
Cervical cancer occurs 80% in developing country including Indonesia and take place in the first rank of incidence rate and third rank in mortality rate in Asian Pacific. Natural history of cervical cancer gives a potential to get accurate screening method. Cervical cancer screening m in Indonesia use VIA and Pap smear method for women in age range 30 to 50 years old. Recently, HPV DNA test has been recommended in international and national policy as primary screening method for cervical cancer. This research aims to asses cost-effectiveness and economic implications of specific cervical cancer screening modalities.
Cost-effectiveness analysis was conducted from societal perspective. Cost data was collected from four hospitals in Indonesia. Direct medical costs were derived from discussions with an expert panel and hospital billing data, aligning with current practice guidelines. Direct and indirect non-medical costs were estimated from patient interviews. Effectiveness data for the screening methods were extracted from a systematic review of existing literature. Markov model design was used for cost-effectiveness analysis. Budget impact analysis used healthcare perspective method from its billing for cervical cancer patients.
Cervical cancer screening costs are calculated using direct medical, non-medical, and indirect expenses. Regarding to cost-effective analysis by incremental cost-effective ratio (ICER), pap smear for every 3 and 5 years is more cost-effective than VIA. HPV DNA also has the potential to be cost-effective. The budget impact analysis investigates scenarios, with a focus on negotiation-based cost reductions for HPV DNA testing. Controlling HPV DNA tariffs at USD 8.76 proves cost-effective.
In conclusion, pap smear is the most cost-effective modality, while HPV DNA has the potential to be cost-effective by reducing the unit cost. Despite favorable outcomes, challenges in implementation suggest a phased approach for resource equalization before full deployment.
宫颈癌在包括印度尼西亚在内的发展中国家发病率占 80%，在亚太地区发病率排名第一，死亡率排名第三。宫颈癌的自然史为准确的筛查方法提供了可能性。印度尼西亚的宫颈癌筛查使用 VIA 和巴氏涂片法，适用于 30 至 50 岁的女性。最近，HPV DNA 检测已被国际和国家政策推荐为宫颈癌的主要筛查方法。本研究旨在评估特定宫颈癌筛查方法的成本效益和经济影响。
从社会角度进行成本效益分析。成本数据从印度尼西亚的四家医院收集。直接医疗成本来自与专家小组的讨论和医院计费数据，与当前的实践指南一致。直接和间接非医疗成本是根据患者访谈估算的。筛查方法的有效性数据从对现有文献的系统评价中提取。使用 Markov 模型设计进行成本效益分析。使用从宫颈癌患者计费角度出发的医疗保健观点方法进行预算影响分析。
宫颈癌筛查成本是通过直接医疗、非医疗和间接费用计算的。关于增量成本效益比（ICER）的成本效益分析，每 3 年和 5 年进行巴氏涂片检查比 VIA 更具成本效益。HPV DNA 也具有成本效益的潜力。预算影响分析研究了各种情况，重点是针对 HPV DNA 检测进行基于谈判的成本降低。将 HPV DNA 关税控制在 8.76 美元以下证明具有成本效益。
总之，巴氏涂片检查是最具成本效益的方法，而 HPV DNA 具有通过降低单位成本实现成本效益的潜力。尽管结果有利，但实施方面的挑战表明，在全面部署之前，需要采取分阶段的方法来实现资源均等化。
