Simple but not simpler: a systematic review of Markov models for economic evaluation of cervical cancer screening

Abstract

The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods).

The prevalence and factors associated with cervical cancer screening among women in the general population: Evidence from National Health Survey

“…Incidence and mortality rates have decreased in high-resource countries. Nowadays, approximately 87% of cervical cancer deaths occur in developing and low-resource countries due to the lack of awareness within their female populations and certain difficulties in running cervical cancer screening programs (Pap test) [3,4].…”

“…Универзитет у Крагујевцу, Факултет медицинских наука, Катедра за епидемиологију, Крагујевац, Србија; 2 Универзитет у Крагујевцу, Факултет медицинских наука, Kатедра за социјалну медицину, Крагујевац, Србија;3 Универзитет у Крагујевцу, Факултет медицинских наука, Катедра за превентивну и дечју стоматологију, Крагујевац, Србија…”

A hidden Markov model for population‐level cervical cancer screening data

“…12 Direct applications to cancer screening include breast, [13][14][15] colorectal, 16 and cervical. [17][18][19][20][21][22] In most of the studies applying Markov models to cervical cancer, including Myers et al 18 and Malagón et al, 19 model parameters are not learned from real-world individual-level panel-data. Instead the Markov models are used as stochastic computational models that study disease progression and regression within a simulated population.…”

“…Furthermore, they do not adequately address parameter uncertainty. 22 In other applications of Markov models to cervical cancer, the focus is on the evaluation of different screening tests or economic impacts. [20][21][22] To the best of our knowledge, the only direct application of HMMs to cervical cancer screening data is by Kirby and Spiegelhalter, 17 which modeled cervical cancer screening as a two-state HMM in continuous-time.…”

Análise Epidemiológica de Câncer de Trato Geniturinário na Região do ABC Paulista

“…Mundialmente, foram 266.000 mortes em 2012, sendo que 87% das mortes ocorre em países menos desenvolvidos. 12 No Brasil, foram diagnosticados 16.370 novos casos em 2018, correspondendo a 8,1% dos cânceres em mulheres. 13 Pela significativa incidência dos cânceres geniturinários em homens e mulheres em nível mundial e nacional, esse estudo tem como objetivo analisar a incidência dos canceres de próstata, colo de útero e bexiga na região de São Paulo e do ABC.…”