System dynamics model of cervical cancer vaccination and screening interventions in Kenya
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RESEARCH
Open Access
System dynamics model of cervical cancer vaccination and screening interventions in Kenya Lucy W Kivuti-Bitok1*, Geoff McDonnell2, Roudsari Abdul3 and Ganesh P Pokhariyal4
Abstract Objectives: This paper presents a simulation model for evaluating the possible effects of a screening and vaccination campaign against Human Papillomavirus [HPV] in Kenya. Method: A System Dynamics model was developed using the iThink™ computer simulation package. The model was based on data extracted from epidemiological, demographic and published research and where data was not available, expert opinion was sought. The deterministic model stratified the population by vaccination status, screening status and HPV infection status. The model was simulated to estimate outputs for the next 50 years from 2011. Cost Utility indicators of Disability Adjusted Life Years (DALYs) and cost per averted DALY were used for economic evaluation. Results: The model predicted that catch up vaccination had the greatest impact in reducing the prevalence of cervical cancer. This was followed by Primary vaccination, with early detection through Screening having the lowest impact of the three choices of interventions in respect of averted cases of cervical cancer and DALY estimates. Conclusion: Kenya as a country should consider adoption of secondary /catch up vaccination as an immediate measure to curb cervical cancer followed by primary vaccination of pre-adolescent girls. Screening should be a complementary measure(s). This model provides a policy decision support vehicle that can allow for choice between different interventions based on their expected outcomes. It also allows modification to accommodate new research results and information to assess the clinical impact of different policies and interventions in cervical cancer management in Kenya. Keywords: Dynamic, Simulation, Cervical, Cancer, Kenya
Introduction Burden of cervical cancer in Kenya
Cervical cancer is estimated to account for 15% of all female cancers and cause approximately 46,000 deaths each year in women aged 15–49 in developing countries [1,2]. Cervical cancer continues to have a devastating effect on women’s health in Kenya. It is the most frequent cancer among women in Kenya. It is also the second most frequent cancer among women between 15 and 44 years of age after breast cancer [3]. Specific disease indicators are summarized in Table 1. A crude incidence rate of 16.5 per 100,000 population per year was reported in Kenya in 2009. Estimates indicate that every year 2600 women are diagnosed with cervical * Correspondence: [email protected] 1 School of Nursing Sciences, University of Nairobi, P.O BOX 19676-KNH-00202, Nairobi, Kenya Full list of author information is available at the end of the article
cancer in Kenya and 2100 die from the disease. It is projected that in 2025, there will be 4100 new cases of cervical cancer in Kenya and 3300 deaths as a result of cervical cancer. Some facilities in the capital city, Nairobi, have reported as high as 10 –
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