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The Ministry of Health Malaysia aims to fully replace liquid-based cytology (LBC) with Human Papillomavirus (HPV) tests and increase the screening coverage from a baseline of 25% to 40% by 2023, followed by a 10% yearly increment until 70% coverage. This transition requires proper planning, including the number of tests needed and budget allocation. This study aims to simulate different transition strategies involving the shift from LBC to HPV testing with expanded screening coverage to predict their impact on cervical cancer elimination in Malaysia. A system dynamics model was developed to simulate the transition from LBC to HPV testing and HPV vaccination coverage in Malaysia. The dynamic model utilised local epidemiological data, published research, and expert opinion when data was unavailable. The simulation showed that a combination of high HPV vaccination coverage and transitioning fully to five-yearly HPV testing by 2030, coupled with a 70% screening uptake by 2040, would accelerate cancer elimination in Malaysia by 18 years with an estimated screening cost of MYR1.81 billion equivalent to USD 411 millions compared to the baseline of using LBC as the primary screening method (MYR1.39 billion, USD 315 millions). Sustained, it would lead to averting 6,000 new cancer cases by 2070. Alternatively, conducting HPV screenings twice before age 50 would advance cervical cancer elimination by 14 years and prevent approximately 1000 new cases by 2070, with an estimated cost of MYR1.13 billion equivalent to USD 257 millions. A delay in achieving the full transition prolonged the elimination more than a delay in increasing the screening coverage. In all scenarios, yearly vaccination of 90% of girls age 13 is crucial to achieving elimination. In the Malaysian context, where HPV vaccination coverage has reached considerable levels, the evidence advocates for a full transition from LBC to HPV testing, ideally by 2030. While expanding screening coverage remains a critical factor in this endeavour, the findings unequivocally endorse prioritising the transition process. Trial registration: Trial registration number: NMRR ID-22-00187-DJU.

马来西亚卫生部的目标是到 2023 年，将液基细胞学（LBC）完全替换为人乳头瘤病毒（HPV）检测，并将筛查覆盖率从 25%提高到 40%，之后每年增加 10%，直到覆盖率达到 70%。这一转变需要进行适当的规划，包括所需的检测数量和预算分配。本研究旨在模拟不同的过渡策略，涉及从 LBC 向 HPV 检测的转变以及扩大筛查范围，以预测其对马来西亚消除宫颈癌的影响。

建立了一个系统动力学模型，以模拟从 LBC 向 HPV 检测和 HPV 疫苗接种覆盖率的转变，以预测其对马来西亚消除宫颈癌的影响。该模型利用了当地的流行病学数据、已发表的研究和专家意见来填补数据空白。模拟结果表明，高 HPV 疫苗接种覆盖率和到 2030 年完全过渡到每五年进行一次 HPV 检测相结合，到 2040 年筛查覆盖率达到 70%，将使马来西亚的癌症消除速度加快 18 年，估计筛查成本为 18.1 亿林吉特（相当于 4110 万美元），而使用 LBC 作为主要筛查方法的基线成本为 13.9 亿林吉特（相当于 3150 万美元）。持续下去，到 2070 年，将避免 6000 例新的癌症病例。或者，在 50 岁之前进行两次 HPV 筛查，将使宫颈癌的消除提前 14 年，到 2070 年将预防约 1000 例新病例，估计成本为 11.3 亿林吉特（相当于 2570 万美元）。完全过渡的延迟比增加筛查覆盖范围的延迟更能延长消除时间。在所有情况下，每年对 13 岁女孩进行 90%的疫苗接种对于实现消除至关重要。在马来西亚，HPV 疫苗接种覆盖率已经达到相当高的水平，证据表明应从 LBC 完全过渡到 HPV 检测，理想情况下应在 2030 年完成。虽然扩大筛查覆盖范围仍然是这一努力的关键因素，但研究结果明确支持优先考虑过渡过程。