Fig. 1.

Markov model structure of cervical cancer and genital warts disease progression. The graph illustrates the Markov model that remodels cervical cancer and genital warts disease progression to evaluate the cost-effectiveness of bivalent, quadrivalent, and nonavalent HPV vaccination. Within the model, each individual transits between health states. A healthy individual may be infected with high-risk HPV (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) and thereafter develop CIN I, CIN II/III, and cervical cancer. Similarly, individuals can also be infected with low-risk HPV (types 6 and 11) and thereafter develop genital warts. Across all disease states, individuals may experience disease regression to the healthy state or eventually die. CIN cervical interstitial neoplasia, HPV human papillomavirus