An updated natural history model of cervical cancer: derivation of model parameters

Am J Epidemiol. 2014 Sep 1;180(5):545-55. doi: 10.1093/aje/kwu159. Epub 2014 Jul 31.

Abstract

Mathematical models of cervical cancer have been widely used to evaluate the comparative effectiveness and cost-effectiveness of preventive strategies. Major advances in the understanding of cervical carcinogenesis motivate the creation of a new disease paradigm in such models. To keep pace with the most recent evidence, we updated a previously developed microsimulation model of human papillomavirus (HPV) infection and cervical cancer to reflect 1) a shift towards health states based on HPV rather than poorly reproducible histological diagnoses and 2) HPV clearance and progression to precancer as a function of infection duration and genotype, as derived from the control arm of the Costa Rica Vaccine Trial (2004-2010). The model was calibrated leveraging empirical data from the New Mexico Surveillance, Epidemiology, and End Results Registry (1980-1999) and a state-of-the-art cervical cancer screening registry in New Mexico (2007-2009). The calibrated model had good correspondence with data on genotype- and age-specific HPV prevalence, genotype frequency in precancer and cancer, and age-specific cancer incidence. We present this model in response to a call for new natural history models of cervical cancer intended for decision analysis and economic evaluation at a time when global cervical cancer prevention policy continues to evolve and evidence of the long-term health effects of cervical interventions remains critical.

Keywords: decision analysis; human papillomavirus; mathematical models; uterine cervical neoplasms.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alphapapillomavirus / genetics*
  • Cervical Intraepithelial Neoplasia / epidemiology
  • Cervical Intraepithelial Neoplasia / prevention & control
  • Cervical Intraepithelial Neoplasia / virology*
  • Computer Simulation*
  • Female
  • Humans
  • Middle Aged
  • Models, Biological*
  • Monte Carlo Method
  • New Mexico / epidemiology
  • Papillomavirus Infections / complications*
  • Papillomavirus Infections / epidemiology
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / prevention & control
  • Uterine Cervical Neoplasms / virology*
  • Young Adult