The key role of mathematical modeling and health economics in the public health transitions in cervical cancer prevention

Mathematical modeling has played a key role in the implementation of major public health transitions in the prevention of cervical and other human papillomavirus (HPV)-related cancers. The natural history of HPV infection and cervical cancer is the most well understood of any cancer, and this has facilitated the development of comprehensive models. The main purpose of modeling is to support the policy-maker in complex areas where there are many options to consider. Clinical trial data for HPV vaccination and primary HPV screening have informed the development of models which have synthesized these findings with in-country information. These models yield predictions of the long-term health outcomes, resource utilization, costs and cost-effectiveness of interventions, and have been critical to the decisions by policy-makers to introduce HPV vaccination and primary HPV screening in many countries. Early models of cervical cancer natural history were reported in the 1980s and 1990s, and 25 years on, several groups around the world have developed comprehensive dynamic platforms of HPV transmission, infection and vaccination, and of cervical cancer natural history and screening. Comparative modeling, where multiple platforms using common input data sources are harnessed, is increasingly used for major evaluations. Looking forward, modeling will continue to play a key role in predicting and optimizing the complex interaction between HPV vaccination and cervical screening. In particular, modeling is critical to underpinning current strategic planning activities for the World Health Organization’s initiative to eliminate cervical cancer as a public health problem.