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Mark Jit Modelling and Economics Unit Health Protection Agency, London

Case study: Structural uncertainty in human papillomavirus vaccination modelling. Mark Jit Modelling and Economics Unit Health Protection Agency, London. M Jit 1,2 , Y Choi 1 , N Gay 1 and WJ Edmunds 1,3 1 Centre for Infections, Health Protection Agency 2 University of Birmingham

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Mark Jit Modelling and Economics Unit Health Protection Agency, London

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  1. Case study: Structural uncertainty in human papillomavirus vaccination modelling Mark Jit Modelling and Economics Unit Health Protection Agency, London M Jit1,2, Y Choi1, N Gay1 and WJ Edmunds1,3 1Centre for Infections, Health Protection Agency 2University of Birmingham 3London School of Hygiene & Tropical Medicine

  2. Outline • Introduction to the problem • Representing structural uncertainty • Selecting optimal scenarios • Presenting results

  3. HPV vaccines 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.

  4. Female HPV prevalence in UK DNA studies

  5. 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. 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.

  6. Types of models used Natural history stage Progression and regression rates Cytological status at time of screening (Cervical screening programme) Type specific HPV prevalence by cytological status (ARTISTIC trial) Sexual transmission stage Changes in disease end points after vaccine introduction Diagnosed anogenital warts cases (GP and GUM clinic returns) Sexual partnership patterns (Sexual lifestyle survey 2000) Duration, QoL detriment of warts episode (York GUM study) Economic stage Changes in the economic burden (cost and quality of life) Cost and quality of life data (current literature)

  7. Natural history stage Progression and regression rates Sexual transmission stage Changes in disease end points after vaccine introduction Economic stage Changes in the economic burden (cost and quality of life)

  8. Natural history stage Progression and regression rates Sexual transmission stage Changes in disease end points after vaccine introduction Economic stage Changes in the economic burden (cost and quality of life) 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).

  9. Natural history stage Progression and regression rates Sexual transmission stage Changes in disease end points after vaccine introduction Economic stage Changes in the economic burden (cost and quality of life)

  10. Natural history stage Progression and regression rates Sexual transmission stage Changes in disease end points after vaccine introduction Economic stage Changes in the economic burden (cost and quality of life)

  11. Natural history stage Progression and regression rates Sexual transmission stage Changes in disease end points after vaccine introduction Economic stage Changes in the economic burden (cost and quality of life)

  12. Natural history stage Progression and regression rates Sexual transmission stage Changes in disease end points after vaccine introduction Economic stage Changes in the economic burden (cost and quality of life)

  13. Natural history stage Progression and regression rates Sexual transmission stage Changes in disease end points after vaccine introduction Economic stage Changes in the economic burden (cost and quality of life)

  14. Natural history stage Progression and regression rates Sexual transmission stage Changes in disease end points after vaccine introduction Economic stage Changes in the economic burden (cost and quality of life)

  15. Natural history stage Progression and regression rates Sexual transmission stage Changes in disease end points after vaccine introduction 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.

  16. 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?

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