title: Development of a quality framework for models of cervical screening and its application to evaluations of the cost-effectiveness of HPV vaccination in developed countries.
abstract: BACKGROUND
  HPV vaccination has now been introduced in most developed countries, but this has occurred in the context of established cervical cancer screening mechanisms which provide population-level protection against the most common HPV-related cancer. Therefore, estimating the cost-effectiveness of HPV vaccination to further reduce HPV-related disease depends in large part on the estimation of the effectiveness of the cervical screening 'background'. The aim of this study was to systematically review and assess methods for simulating cervical screening in decision analytic models used for evaluation of HPV vaccination.
  
  
  METHODS
  Existing quality frameworks for economic models were extended to develop a specific quality framework for models of cervical screening. This involved domains for model structure, parameterisation (data sources) and validation (consistency). A systematic review of economic evaluations of HPV vaccination was then conducted, and assessment of cervical screening model components was then performed via application of the new quality framework.
  
  
  RESULTS
  Generally, models took into account population-level cervical screening participation, but were inconsistent in their approach to modelling abnormal smear management, diagnostic evaluation and treatment of precancerous disease. There was also considerable variability in the accuracy of modelling clinical pathways and the scope of validation performed for screening-related outcomes, with focus directed towards cervical cancer targets. Only a few models comprehensively validated against observed pre-cancerous abnormalities.
  
  
  CONCLUSIONS
  Models of HPV vaccination in developed countries can be improved by further attention to the 'background' modelling of secondary protection via cervical screening. The quality framework developed for this review can be used to inform future HPV vaccination evaluations, including evaluations of the cost-effectiveness of male vaccination and next generation HPV vaccines, and to assess models used to evaluate new cervical screening technologies and recommendations.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Simonella
authors.affiliation: Lowy Cancer Research Centre, Prince of Wales Clinical School, The University of NSW, Sydney, Australia. Electronic address: k.canfell@unsw.edu.au.
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
mesh_terms: D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D003362:Cost-Benefit Analysis; D019049:Developed Countries; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014611:Vaccination / Q000191:economics* / Q000379:methods
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical screening; HPV vaccination; Quality framework; Systematic review