Table 1.
Input variables and sources*
| Clinical variable | Base-case value | Range | Source |
|---|---|---|---|
| Population variables | |||
| Annual hysterectomy rate† (%) | 0.02 – 1.17 | Keshavarz (2002) | |
| Age-specific prevalence of HR HPV infection†‡(%) | 4 – 31 | 0.5 – 2x baseline | Apple |
|
| |||
| Probability of disease progression | |||
| HPV infection progressing to CIN 1 (%) | 8.1 | 5.4-15.0 | Ho (1998) |
| Prevalence of LSIL among patients with non 16/18 HR HPV infection (%) | 14 | 0.5 – 2x baseline | Herrero (2005) |
| RR of LSIL among patients with HPV-16 infection§ | 1 | “ | Assumption |
| RR of LSIL among patients with HPV-18 infection§ | 1 | “ | Assumption |
| HPV infection progressing to CIN 2,3 (%) | 0.56 | 0.54-1.5 | Ho (1998), Myers (2000) |
| Prevalence of CIN 2,3 among patients with non 16/18 HR HPV infection (%) | 4 | 0.5 – 2x baseline | Khan (2005) |
| Progression from CIN 1 to CIN 2,3† (%) | 1.7 – 5.7 | 1.7-8.3 | Myers (2000) |
| Annual rate of progression among patients with non 16/18 HR HPV infection | 0.09 | 0.5 -2x baseline | Khan (2005) |
| RR of CIN 2,3 in patients with HPV-16 infection§ | 4.6 | “ | Khan (2005) |
| RR of CIN 2,3 in patients with HPV-18 infection§ | 2.5 | “ | ∥ |
| Progression from CIN 2,3 to cervical cancer (%) | 3.8 | 3.0-6.2 | Sanders (2003) |
| Incidence rate of cervical cancer in the United States (per 100,000 women) | 9.4 | 0.5 – 2x baseline | Saraiya (2007) |
| Prevalence of HPV-16 in patients with cervical cancer (%) | 59 | 55-63 | Clifford (2003), Munoz (2003) |
| Prevalence of HPV-18 in patients with cervical cancer (%) | 13 | 11-15 | |
| Prevalence of non 16/18 HR HPV types in patients with cervical cancer (%) | 28 | 22-34 | |
|
| |||
| Probability of cervical cancer progression (%) ¥ | 43.7-68.3 | 40-70 | Myers (2000), Sanders (2003) |
|
| |||
| Probability of disease regression | |||
| Age-specific probability of regression of HPV infection† (%) | 3.3 – 37.3 | 1.7-60.0 | Myers (2000), Ho (1998) |
| Rate of clearance of non 16/18 HR HPV infection | 1.29 | 0.5 – 2x baseline | Trottier (unpublished manuscript) |
| RR of clearance of HPV-16 infection§ | 0.85 | “ | Trottier |
| RR of clearance of HPV-18 infection§ | 0.96 | “ | Trottier |
| Regression of CIN 1† (%) | 2.7 – 14.2 | 2 – 16 | Sanders (2003) |
| Patients regressing to HPV infection without lesion (%) | 10 | 0 – 20 | Sanders (2003), Myers (2000) |
| Regression rate of LSIL among patients with non 16/18 HR HPV infection | 0.98 | 0.5 – 2x baseline | Schlecht (2003) |
| RR of regression of LSIL in patients with HPV-16§ | 0.91 | “ | “ |
| RR of regression of LSIL in patients with HPV-18§ | 0.91 | “ | Assumption |
| Regression of CIN 2,3† (%) | 3.7 – 5.8 | 3-7 | Sanders (2003), Myers (2000) |
| Patients regressing to normal (%) | 45 | 40-50 | “ |
| Patients regressing to HPV infection without lesion (%) | 5 | 0-10 | “ |
| Patients regressing to CIN 1 (%) | 50 | 40-60 | “ |
| Regression rate of HSIL among patients with non 16/18 HR HPV infection | 0.77 | 0.5 – 2x baseline | Schlecht (2003) |
| RR of regression of HSIL in patients with HPV-16§ | 0.27 | “ | “ |
| RR of regression of HSIL in patients with HPV-18§ | 0.27 | “ | “ |
|
| |||
| Annual symptom detection probability for cervical cancer (%) ¥ | 15-90 | 12-93 | Sanders (2003) |
|
| |||
| 5-year survival rates (% alive at 5 years) ¥ | 85-12 | 84-10 | NCDB commission on cancer (2006) |
|
| |||
| Disease-specific utilities | Sanders (2003) | ||
| HPV infection | 1 | 0.8-1 | |
| CIN 1 | 0.97 | 0.8-1 | |
| CIN 2,3 | 0.97 | 0.5-1 | |
| Invasive cervical cancer ¥ | 0.79-0.62 | 0.25-1 | |
|
| |||
| Initial efficacy of treatment (%) | Karyn Goodman (personal communication), Assumption | ||
| CIN 1 | 98 | 95-100 | |
| CIN 2 | 95 | 90-98 | |
| Invasive cervical cancer¥ | 90-15 | 10-100 | |
| Probability HPV persists after effective treatment (%) | Sanders (2003) | ||
| CIN 1 | 10 | 0-25 | |
| CIN 2,3 | 10 | 0-25 | |
| Invasive cervical cancer | 0 | --- | Assumption |
|
| |||
| Screening tests (%) | Sensitivity | Specificity | |
| Liquid-based cytology (ASCUS or worse) | |||
| CIN 1 or worse | 43 | 85 | Ratnam (2000) |
| CIN 2,3 or worse | 53 | 96 | Cuzick (2006) |
| HPV positive | |||
| CIN 1 or worse | 57 | 96 | Bigras (2005) |
| CIN 2,3 or worse | 96 | 91 | Cuzick (2006) |
*
All variables are annual unless otherwise noted. HR denotes high risk, HPV human papillomavirus, CIN cervical intraepithelial neoplasia, LSIL low-grade squamous intraepithelial lesion, RR relative risk, FIGO International Federation of Gynecology and Obstetrics, HSIL high-grade squamous intraepithelial lesion, NCDB National Cancer Database, and ASCUS atypical squamous cells of undetermined significance.
†
These data vary based on age. The range of values is shown.
‡
These data also vary by HPV type.
§
Compared to patients with non 16/18 HR HPV infection
∥
Estimated using a Markov model to match the incidence of CIN 2,3 and cervical cancer in the United States
¥
These data vary based on cervical cancer stage (FIGO I, II, III or IV)