Fine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case study
Abstract Background Cervical cancer (CC) is globally ranked fourth in terms of incidence and mortality among women. Vaccination against Human Papillomavirus (HPV) and screening programs can significantly reduce CC mortality rates. Hence, executing cost-effective public health policies for prevention...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-08-01
|
| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-023-16022-x |
| _version_ | 1797752564612071424 |
|---|---|
| author | Daniela Angulo Maria Fernanda Cortes Ivan Mura Raha Akhavan-Tabatabaei |
| author_facet | Daniela Angulo Maria Fernanda Cortes Ivan Mura Raha Akhavan-Tabatabaei |
| author_sort | Daniela Angulo |
| collection | DOAJ |
| description | Abstract Background Cervical cancer (CC) is globally ranked fourth in terms of incidence and mortality among women. Vaccination against Human Papillomavirus (HPV) and screening programs can significantly reduce CC mortality rates. Hence, executing cost-effective public health policies for prevention and surveillance is crucial. However, defining policies that make the best use of the available resources is not easy, as it requires predicting the long-term costs and results of interventions on a changing population. Since the simpler task of predicting the results of public health policies is difficult, devising those that make the best usage of available resources is an arduous challenge for decision-makers. Methods This paper proposes a fine-grained epidemiological simulation model based on differential equations, to effectively predict the costs and effectiveness of CC public health policies that include vaccination and screening. The model represents population dynamics, HPV transmission within the population, likelihood of infection clearance, virus-induced appearance of precancerous lesions and eventually CC, as well as immunity gained with vaccination and early detection with screening. Results We offer a compartmentalized modeling approach that separates population, epidemics, and intervention concerns. We instantiate models with actual data from a Colombian case study and analyze their results to show how our modeling approach can support CEA studies. Moreover, we implement models in an open-source software tool to simultaneously define and evaluate multiple policies. With the support of the tool, we analyze 54 policies within a 30-year time horizon and use as a comparator the CC policy that has been used until recently. We identify 8 dominant policies, the best one with an ICER of 6.3 million COP (Colombian Pesos) per averted DALY. We also validate the modeling approach against the available population and HPV epidemic data. The effects of uncertainty in the values of key parameters (discount rate, sensitivity of screening tests) is evaluated through one-way sensitivity analysis. Conclusions Our modeling approach can provide valuable support for healthcare decision-makers. The implementation into an automated tool allows customizing the analysis with country-specific data, flexibly defining public health policies to be evaluated, and conducting disaggregate analyses of their cost and effectiveness. |
| first_indexed | 2024-03-12T17:06:10Z |
| format | Article |
| id | doaj.art-8a59f6883cca4a949d3ea09b6de773ee |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-12T17:06:10Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-8a59f6883cca4a949d3ea09b6de773ee2023-08-06T11:26:51ZengBMCBMC Public Health1471-24582023-08-0123112410.1186/s12889-023-16022-xFine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case studyDaniela Angulo0Maria Fernanda Cortes1Ivan Mura2Raha Akhavan-Tabatabaei3Department of Biostatistics, University of MichiganDepartment of Industrial Engineering, Universidad de los AndesInstitute of Applied Physical Sciences and Engineering, and Global Health Research Center, Duke Kunshan UniversitySchool of Management, Sabanci UniversityAbstract Background Cervical cancer (CC) is globally ranked fourth in terms of incidence and mortality among women. Vaccination against Human Papillomavirus (HPV) and screening programs can significantly reduce CC mortality rates. Hence, executing cost-effective public health policies for prevention and surveillance is crucial. However, defining policies that make the best use of the available resources is not easy, as it requires predicting the long-term costs and results of interventions on a changing population. Since the simpler task of predicting the results of public health policies is difficult, devising those that make the best usage of available resources is an arduous challenge for decision-makers. Methods This paper proposes a fine-grained epidemiological simulation model based on differential equations, to effectively predict the costs and effectiveness of CC public health policies that include vaccination and screening. The model represents population dynamics, HPV transmission within the population, likelihood of infection clearance, virus-induced appearance of precancerous lesions and eventually CC, as well as immunity gained with vaccination and early detection with screening. Results We offer a compartmentalized modeling approach that separates population, epidemics, and intervention concerns. We instantiate models with actual data from a Colombian case study and analyze their results to show how our modeling approach can support CEA studies. Moreover, we implement models in an open-source software tool to simultaneously define and evaluate multiple policies. With the support of the tool, we analyze 54 policies within a 30-year time horizon and use as a comparator the CC policy that has been used until recently. We identify 8 dominant policies, the best one with an ICER of 6.3 million COP (Colombian Pesos) per averted DALY. We also validate the modeling approach against the available population and HPV epidemic data. The effects of uncertainty in the values of key parameters (discount rate, sensitivity of screening tests) is evaluated through one-way sensitivity analysis. Conclusions Our modeling approach can provide valuable support for healthcare decision-makers. The implementation into an automated tool allows customizing the analysis with country-specific data, flexibly defining public health policies to be evaluated, and conducting disaggregate analyses of their cost and effectiveness.https://doi.org/10.1186/s12889-023-16022-xCervical cancerPublic health policyCost-effectiveness analysisSimulation modelAutomation |
| spellingShingle | Daniela Angulo Maria Fernanda Cortes Ivan Mura Raha Akhavan-Tabatabaei Fine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case study BMC Public Health Cervical cancer Public health policy Cost-effectiveness analysis Simulation model Automation |
| title | Fine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case study |
| title_full | Fine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case study |
| title_fullStr | Fine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case study |
| title_full_unstemmed | Fine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case study |
| title_short | Fine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case study |
| title_sort | fine grained mathematical modeling for cost effectiveness evaluation of public health policies for cervical cancer with application to a colombian case study |
| topic | Cervical cancer Public health policy Cost-effectiveness analysis Simulation model Automation |
| url | https://doi.org/10.1186/s12889-023-16022-x |
| work_keys_str_mv | AT danielaangulo finegrainedmathematicalmodelingforcosteffectivenessevaluationofpublichealthpoliciesforcervicalcancerwithapplicationtoacolombiancasestudy AT mariafernandacortes finegrainedmathematicalmodelingforcosteffectivenessevaluationofpublichealthpoliciesforcervicalcancerwithapplicationtoacolombiancasestudy AT ivanmura finegrainedmathematicalmodelingforcosteffectivenessevaluationofpublichealthpoliciesforcervicalcancerwithapplicationtoacolombiancasestudy AT rahaakhavantabatabaei finegrainedmathematicalmodelingforcosteffectivenessevaluationofpublichealthpoliciesforcervicalcancerwithapplicationtoacolombiancasestudy |