Abstract
Introduction: The optimal screening strategy for early anal cancer detection in men who have sex with men (MSM) living with HIV is unknown.
Methods: We estimated the cost-effectiveness of regular anal examinations to screen for anal cancer in HIV-positive men MSM living in Australia using a probabilistic Markov model. Data sources were based on the medical literature and a clinical trial of HIV-positive MSM receiving an annual anal examination in Australia. The main outcome measures were undiscounted and discounted (at 3%) lifetime costs, life years gained, quality adjusted life years (QALY) gained and incremental cost-effectiveness ratio (ICER).
Results: Base-case analysis estimated the average cost of screening for and management of anal cancer ranged from $195 for no screening to $1,915 for lifetime annual screening of men aged ≥50 years. The incremental discounted, QALYs gained ranged from 0.02 for 4 yearly screening to 0.03 for annual screening of men aged ≥50 years. Screening of men aged ≥50 years generated ICERs of $29,760 per QALY gained (for screening every 4 years), $32,222 (every 3 years), and $45,484 (every 2 years). Uncertainty for ICERs were most influenced by the cost (financially and decrease in quality of life) from a false positive result, specificity of the anal examination, the probability of detection outside a screening program and the discount rate.
Conclusion: In settings where anal cytology for screening precursors of anal cancer is not available, screening for anal cancer by incorporating regular anal examinations into routine HIV care for MSM aged ≥50 years is most likely to be cost-effective by conventional standards.
Methods: We estimated the cost-effectiveness of regular anal examinations to screen for anal cancer in HIV-positive men MSM living in Australia using a probabilistic Markov model. Data sources were based on the medical literature and a clinical trial of HIV-positive MSM receiving an annual anal examination in Australia. The main outcome measures were undiscounted and discounted (at 3%) lifetime costs, life years gained, quality adjusted life years (QALY) gained and incremental cost-effectiveness ratio (ICER).
Results: Base-case analysis estimated the average cost of screening for and management of anal cancer ranged from $195 for no screening to $1,915 for lifetime annual screening of men aged ≥50 years. The incremental discounted, QALYs gained ranged from 0.02 for 4 yearly screening to 0.03 for annual screening of men aged ≥50 years. Screening of men aged ≥50 years generated ICERs of $29,760 per QALY gained (for screening every 4 years), $32,222 (every 3 years), and $45,484 (every 2 years). Uncertainty for ICERs were most influenced by the cost (financially and decrease in quality of life) from a false positive result, specificity of the anal examination, the probability of detection outside a screening program and the discount rate.
Conclusion: In settings where anal cytology for screening precursors of anal cancer is not available, screening for anal cancer by incorporating regular anal examinations into routine HIV care for MSM aged ≥50 years is most likely to be cost-effective by conventional standards.
| Original language | English |
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| Pages | A166 |
| Number of pages | 1 |
| DOIs | |
| Publication status | Published - 2015 |
| Event | STI & HIV World Congress 2015 - Brisbane Convention & Exhibition Centre, Brisbane, Australia Duration: 13 Sep 2015 → 16 Sep 2015 |
Conference
| Conference | STI & HIV World Congress 2015 |
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| Country | Australia |
| City | Brisbane |
| Period | 13/09/15 → 16/09/15 |