Table 1.
Markov model input parameters: transition probabilities, utilities, and costs
| Parameter | Value | 95% CI | Distribution | References | |
|---|---|---|---|---|---|
| Transition probabilities | |||||
| From healthy to HR infection | 0.1320 | 0.1173 | 0.1485 | Dirichlet | [36] |
| From healthy to LR infection | 0.0650 | 0.0548 | 0.0761 | Dirichlet | [36] |
| From healthy, infection, or genital warts to dead (9–34 years) | 0.0024 | [22] | |||
| From healthy, infection, or genital warts to dead (35–70 years) | 0.0105 | [22] | |||
| From HR infection to CIN I (9–34 years) | 0.0878 | 0.0591 | 0.1164 | Dirichlet | [48–50] |
| From HR infection to CIN I (35–70 years) | 0.0824 | 0.1351 | 0.0298 | Dirichlet | [48–50] |
| From HR infection to CIN II/III (9–34 years) | 0.0070 | 0.0020 | 0.0120 | Dirichlet | [48–50] |
| From HR infection to CIN II/III (35–70 years) | 0.0287 | 0.0080 | 0.0494 | Dirichlet | [48–50] |
| From HR infection to cervical cancer | 0.0000 | [48–50] | |||
| From HR infection to healthy | 0.3900 | 0.2900 | 0.4900 | Dirichlet | [48–50] |
| From LR infection to genital warts | 0.0297 | 0.0001 | 0.0592 | Dirichlet | [48, 49, 51] |
| From LR infection to healthy | 0.4100 | 0.3100 | 0.5100 | Dirichlet | [48–50] |
| From CIN I to CIN II/III (9–34 years) | 0.0567 | 0.0159 | 0.0975 | Dirichlet | [48–50] |
| From CIN I to CIN II/III (35–70 years) | 0.2321 | 0.0726 | 0.3916 | Dirichlet | [48–50] |
| From CIN I to healthy | 0.4982 | 0.2079 | 0.7884 | Dirichlet | [48–50] |
| From CIN II/III to cervical cancer | 0.0480 | 0.0370 | 0.0750 | Dirichlet | [27] |
| From CIN II/III to healthy | 0.0370 | 0.0170 | 0.0570 | Dirichlet | [48–50] |
| From cervical cancer to healthy | 0.1560 | 0.1250 | 0.1870 | Dirichlet | [48–50] |
| From cervical cancer to dead | 0.1060 | 0.0850 | 0.1270 | Dirichlet | [48–50] |
| From genital warts to healthy | 0.7140 | 0.5881 | 0.8124 | Dirichlet | [53] |
| Utilities (in QALY) | |||||
| Associated with state healthy | 1.00 | ||||
| Associated with state HR infection | 1.00 | 0.80 | 1.00 | Beta | [27, 50] |
| Associated with state LR infection | 1.00 | 0.80 | 1.00 | Beta | [27, 50] |
| Associated with state CIN I cancer | 0.91 | 0.86 | 0.96 | Beta | [30, 54] |
| Associated with state CIN II/III cancer | 0.87 | 0.83 | 0.91 | Beta | [30, 54] |
| Associated with state cervical cancer | 0.56 | 0.48 | 0.65 | Beta | [30, 54] |
| Associated with state genital warts | 0.82 | 0.80 | 0.84 | Beta | [40] |
| Associated with state dead | 0.00 | ||||
| Direct medical costs (in R) | |||||
| Associated with state healthy | 0.00 | ||||
| Associated with state HR infection | 0.00 | ||||
| Associated with state LR infection | 0.00 | ||||
| Associated with state CIN I cancer | 1385.66 | 1108.53 | 1662.79 | Gamma | [27] |
| Associated with state CIN II/III cancer | 2767.34 | 2213.87 | 3320.81 | Gamma | [27] |
| Associated with state cervical cancer | 118,506.78 | 94,805.43 | 142,208.14 | Gamma | [27] |
| Associated with state genital warts | 1095.42 | 547.71 | 1643.13 | Gamma | [28] |
| Associated with state dead | 0.00 | ||||
| Vaccine and equipment costs (in R) | |||||
| Bivalent vaccine (Cervarix®) | 139.82 | 133.58 | 146.07 | Gamma | [24–26] |
| Quadrivalent vaccine (Gardasil®) | 174.78 | 166.97 | 182.58 | Gamma | [24–26] |
| Nonavalent vaccine (Gardasil9®) | 3923.75 | 3748.51 | 4098.98 | Gamma | [24–26] |
| Bivalent booster shot (Cervarix®) | 70.59 | 67.33 | 73.85 | Gamma | [24–26] |
| Quadrivalent booster shot (Gardasil®) | 88.24 | 84.16 | 92.31 | Gamma | [24–26] |
| Nonavalent booster shot (Gardasil9®) | 1980.92 | 1889.49 | 2072.35 | Gamma | [24–26] |
| PAP smear | 623.61 | 342.98 | 966.59 | Gamma | [30] |
Costs are displayed in 2019 R
Vaccine cost calculations are enclosed in electronic supplementary Tables e1 and e2
CI confidence interval, CIN cervical interstitial neoplasia, HR high-risk, LR low-risk, PAP Papanicolaou, QALY quality-adjusted life-year, R South African Rand