Mathematical Models for Predicting the Epidemiologic and Economic Impact of Vaccination against Human Papillomavirus Infection and Disease

Infection with human papillomavirus (HPV) is the primary causeof cervical cancer, other anogenital cancers, genital warts,and recurrent respiratory papillomatosis. Clinical studies havedemonstrated that a prophylactic HPV vaccine can prevent infection,genital warts, and the precancerous lesions that lead to cervicalcancer. Given the absence of data on the long-term effectivenessof HPV vaccination, a number of mathematical models have beendeveloped to provide insight to policy makers by projectingthe long-term epidemiologic and economic consequences of vaccinationand evaluate alternative vaccination policies. This paper reviewsthe state of these models. Three types of HPV mathematical modelshave been reported in the literature: cohort, population dynamic,and hybrid. All have demonstrated that vaccination can significantlyreduce the incidence of cervical cancer in the long term. However,only the cohort and hybrid models have evaluated the cost-effectivenessof vaccination strategies for preventing cervical cancer. Thesemodels have generally shown that vaccinating females can becost-effective. None has accounted for the potential benefitsof vaccinating the population to reduce the burden of recurrentrespiratory papillomatosis and cancers of the vagina, vulva,anus, penis, and head/neck. Given that only the population dynamicmodel can account for both the direct and indirect (i.e., herdimmunity effects) benefits of vaccination in the population,future research should focus on further development of dynamicmodels by expanding the range of epidemiologic outcomes trackedand including the ability to assess the cost-effectiveness ofalternative vaccination policies. cost-benefit analysis • economics • papillomavirus, human • vaccines