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![Page 1: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/1.jpg)
Mark Jit
Modelling and Economics Unit
Health Protection Agency, London
Case study: Structural uncertainty in
human papillomavirus vaccinationmodelling
M Jit1,2, Y Choi1, N Gay1 and WJ Edmunds1,3
1Centre for Infections, Health Protection Agency2University of Birmingham3London School of Hygiene & Tropical Medicine
![Page 2: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/2.jpg)
Outline
• Introduction to the problem
• Representing structural uncertainty
• Selecting optimal scenarios
• Presenting results
![Page 3: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/3.jpg)
![Page 4: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/4.jpg)
GardasilTM • Protects against HPV 6, 11, 16, 18.
• Doses at 0, 2, 6 months.
• Aluminium adjuvanted.
• Licensed widely, in use in several countries.
CervarixTM • Protects against HPV 16, 18.
• Doses at 0, 1, 6 months.
• AS04 adjuvanted.
• Licensed in Europe and Australia.
HPV vaccines
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Female HPV prevalence in UK DNA studies
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Epidemiological uncertainty
Progression and regression of HPV-related neoplastic states.
Duration of HPV infection.
Prevalence of anogenital warts among HPV 6 and 11 infected people.
Duration of vaccine protection.
Coverage of vaccination programme.
Uncertainty about disease burden
Cost and QoL impact of screening.
Cost and QoL impact of treating neoplasias, cancer, warts.
Accuracy of cytological screening and DNA testing.
Structural uncertainty
Natural regression of HPV-related neoplasias.
Existence of natural immunity to HPV.
Pattern of sexual partnerships between age and risk groups.
Vaccine protection against non-vaccine HPV types.
![Page 7: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/7.jpg)
Sexual transmission stage
Changes in disease end points after
vaccine introduction
Type specific HPV prevalence by
cytological status (ARTISTIC trial)
Natural history stage
Progression and regression rates
Economic stage
Changes in the economic burden
(cost and quality of life)
Cytological status at time of screening
(Cervical screening programme)
Sexual partnership patterns
(Sexual lifestyle survey 2000)
Cost and quality of life data
(current literature)
Diagnosed anogenital warts
cases
(GP and GUM clinic returns)
Duration, QoL detriment of warts
episode
(York GUM study)
Types of models used
![Page 8: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/8.jpg)
Sexual transmission stage
Changes in disease end points after
vaccine introduction
Natural history stage
Progression and regression rates
Economic stage
Changes in the economic burden
(cost and quality of life)
![Page 9: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/9.jpg)
Jit M, Gay N, Soldan K, Choi YH, Edmunds WJ. Estimating progression rates for human papillomavirus infection from epidemiological data. Medical Decision Making (in press).
Sexual transmission stage
Changes in disease end points after
vaccine introduction
Natural history stage
Progression and regression rates
Economic stage
Changes in the economic burden
(cost and quality of life)
![Page 10: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/10.jpg)
Economic stage
Changes in the economic burden
(cost and quality of life)
Sexual transmission stage
Changes in disease end points after
vaccine introduction
Natural history stage
Progression and regression rates
![Page 11: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/11.jpg)
Economic stage
Changes in the economic burden
(cost and quality of life)
Sexual transmission stage
Changes in disease end points after
vaccine introduction
Natural history stage
Progression and regression rates
![Page 12: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/12.jpg)
Natural history stage
Progression and regression rates
Economic stage
Changes in the economic burden
(cost and quality of life)
Sexual transmission stage
Changes in disease end points after
vaccine introduction
![Page 13: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/13.jpg)
Natural history stage
Progression and regression rates
Economic stage
Changes in the economic burden
(cost and quality of life)
Sexual transmission stage
Changes in disease end points after
vaccine introduction
![Page 14: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/14.jpg)
Natural history stage
Progression and regression rates
Economic stage
Changes in the economic burden
(cost and quality of life)
Sexual transmission stage
Changes in disease end points after
vaccine introduction
![Page 15: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/15.jpg)
Sexual transmission stage
Changes in disease end points after
vaccine introduction
Natural history stage
Progression and regression rates
Economic stage
Changes in the economic burden
(cost and quality of life)
![Page 16: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/16.jpg)
Sexual transmission stage
Changes in disease end points after
vaccine introduction
Natural history stage
Progression and regression rates
Economic stage
Changes in the economic burden
(cost and quality of life)
Jit M, Choi YH, Edmunds WJ. Economic evaluation of human papillomavirus vaccination in the United Kingdom. BMJ 2008; 337:a769.
![Page 17: Mark Jit Modelling and Economics Unit Health Protection Agency, London Case study: Structural uncertainty in human papillomavirus vaccination modelling.](https://reader035.fdocuments.us/reader035/viewer/2022062620/551ae4af5503466b6a8b5d9f/html5/thumbnails/17.jpg)
Some relevant issues that were raised during this work
When is uncertainty structural rather than parametric?
How should different structural scenarios be weighed or selected?
How can we improve the computational efficiency of structural uncertainty analysis?