Modelling the epidemic dynamics of HPV among women in China and optimization of ongoing cervical cancer elimination strategies

Background The infection of high-risk human papillomavirus (hr-HPV) and related cervical cancer have greatly threatened women health. However, the benefits of ongoing strategies in China remains unclear. Insufficient vaccine supply and excessive screening workload have hindered the widespread implementation of HPV immunization plans. Methods We constructed stratified mathematical models to simulate the transmission of hr-HPV among women under ongoing strategies, and calculated the incremental cost-utility ratio (ICUR) to compare the health-economics benefits among different intervention pathways, including different vaccine type and dose schedules, commonly recommended screening algorithms as well as AI-assisted TCT method. The model parameters were calibrated according to real-world HPV prevalences, incorporating segmented model assumptions reflecting the levels of COVID-19 lockdown. Results The model shows that ongoing strategies in China are projected to reducing cervical cancer prevalence continuously and demonstrate good cost-utility (ICUR: 22,532.04 USD/QALY, 21,968.74-23,095.34), when increasing the participation rate to achieve the global goal by 2030. HPV vaccination provides substantial health benefits, while cannot improve the cost-utility at current cost. Offering single-dose of 2vHPV vaccine to girls before the age of 14 and reallocating excess doses to women under 25 yields a lower ICUR compared to two- or three-dose scenarios. Cervical screening can significantly reduce the ICUR. Among the screening methods, HPV testing demonstrates higher cost-utility, while AI-TCT outperforms all recommended traditional pathways. Conclusion The ongoing strategies demonstrate substantial health and economic benefits in achieving the 2030 global target; however, neither screening nor vaccination alone can deliver optimal effectiveness. The findings highlight the importance of combining vaccination and screening, and provide evidence for the promotion of single-dose vaccination and AI-TCT projects to alleviate resource burdens.