Infectious Disease Control and Vaccinations, National Institute for Health and Welfare (THL), Helsinki, Finland; School of Health Sciences, University of Tampere, Tampere, Finland; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland.
Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
Math Biosci. 2019 Mar;309:92-106. doi: 10.1016/j.mbs.2019.01.006. Epub 2019 Jan 16.
Cervical cancer arises differentially from infections with up to 14 high-risk human papillomavirus (HPV) types, making model-based evaluations of cervical cancer screening strategies computationally heavy and structurally complex. Thus, with the high number of HPV types, microsimulation is typically used to investigate cervical cancer screening strategies. We developed a feasible deterministic model that integrates varying natural history of cervical cancer by the different high-risk HPV types with compressed mixture representations of the screened population, allowing for fast computation of screening interventions. To evaluate the method, we built a corresponding microsimulation model. The outcomes of the deterministic model were stable over different levels of compression and agreed with the microsimulation model for all disease states, screening outcomes, and levels of cancer incidence. The compression reduced the computation time more than 1000 fold when compared to microsimulation in a cohort of 1 million women. The compressed mixture representations enable the assessment of uncertainties surrounding the natural history of cervical cancer and screening decisions in a computationally undemanding way.
宫颈癌是由多达 14 种高危型人乳头瘤病毒(HPV)感染引起的,这使得基于模型的宫颈癌筛查策略评估在计算上非常繁重且结构复杂。因此,由于 HPV 类型数量众多,通常使用微模拟来研究宫颈癌筛查策略。我们开发了一种可行的确定性模型,该模型通过不同的高危 HPV 类型整合了宫颈癌的不同自然史,并对筛查人群进行了压缩混合表示,从而可以快速计算筛查干预措施。为了评估该方法,我们构建了相应的微模拟模型。确定性模型的结果在不同的压缩水平上是稳定的,并且与微模拟模型在所有疾病状态、筛查结果和癌症发病率水平上一致。与微模拟相比,在 100 万女性的队列中,压缩可将计算时间减少 1000 多倍。压缩混合表示使得能够以计算要求不高的方式评估宫颈癌自然史和筛查决策的不确定性。