HPV and cervical cancer in Moldova, epidemiological model with intervention cost vs benefit and effectiveness analysis

Abstract: Human papillomavirus, or HPV, is a sexually transmittable virus infection, which is necessary risk factor for developing cervical cancer, first most common type of cancer in working age women in Moldova. We observe both behavioral change (sexuality increase) and demographical change (population ageing). We used data since 1998 (Moldovan peace treaty) to adjust model parameter and we project till around 2030 (for vaccination till 2050). According to provided information, interdisciplinary model was proposed. It iss set of deterministic differential equations. Stochasticity was introduced in sexual partner change rates. The model has aggregated the most important paths of infection, cancer development and prevention scenarios (more than 100 equations and 200 parameters). Moldovan cervical cancer perspective looks much better, than in central western Europe countries, because of relatively young society. In our setup, obligatory vaccination seems to not be so crucial (for none of realistic scenarios increase of cancer cases is possible) for public health, as in most countries in European Union. However, screening practice could be verified in terms of efficiency, when cost benefit calculation would be done. We propose more optimal screening guidelines (with prevention cost 5 -10k EUR per QALY), which could provide saving perspective in 10-15 year in range 150-300k EUR yearly. Targeted vaccination could be also consider, because costs are similar to high frequencies screening schema with the same cancer cases projection. However, some positive side effects of vaccination as reduction of pathogen circulation in society, will cause decrease of other pathologies related to HPV like genital warts and other cancer.