Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in hiv-positive men who have sex with men

Jason Jiat Shern Ong, Christopher K Fairley, Susan Carroll, Sandra Margaret Walker, Marcus Chen, Timothy Richard Read, Catriona Bradshaw, Andrew Grulich, John Martin Kaldor, Philip Clarke

Research output: Contribution to conferencePosterOther

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.
Original languageEnglish
PagesA166
Number of pages1
DOIs
Publication statusPublished - 2015
EventWorld STI & HIV Congress - Brisbane Convention & Exhibition Centre, Brisbane, Australia
Duration: 13 Sep 201516 Sep 2015

Conference

ConferenceWorld STI & HIV Congress
CountryAustralia
CityBrisbane
Period13/09/1516/09/15

Cite this

Ong, J. J. S., Fairley, C. K., Carroll, S., Walker, S. M., Chen, M., Read, T. R., ... Clarke, P. (2015). Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in hiv-positive men who have sex with men. A166. Poster session presented at World STI & HIV Congress, Brisbane, Australia. https://doi.org/10.1136/sextrans-2015-052270.433
Ong, Jason Jiat Shern ; Fairley, Christopher K ; Carroll, Susan ; Walker, Sandra Margaret ; Chen, Marcus ; Read, Timothy Richard ; Bradshaw, Catriona ; Grulich, Andrew ; Kaldor, John Martin ; Clarke, Philip. / Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in hiv-positive men who have sex with men. Poster session presented at World STI & HIV Congress, Brisbane, Australia.1 p.
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title = "Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in hiv-positive men who have sex with men",
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.",
author = "Ong, {Jason Jiat Shern} and Fairley, {Christopher K} and Susan Carroll and Walker, {Sandra Margaret} and Marcus Chen and Read, {Timothy Richard} and Catriona Bradshaw and Andrew Grulich and Kaldor, {John Martin} and Philip Clarke",
year = "2015",
doi = "10.1136/sextrans-2015-052270.433",
language = "English",
pages = "A166",
note = "World STI & HIV Congress ; Conference date: 13-09-2015 Through 16-09-2015",

}

Ong, JJS, Fairley, CK, Carroll, S, Walker, SM, Chen, M, Read, TR, Bradshaw, C, Grulich, A, Kaldor, JM & Clarke, P 2015, 'Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in hiv-positive men who have sex with men' World STI & HIV Congress, Brisbane, Australia, 13/09/15 - 16/09/15, pp. A166. https://doi.org/10.1136/sextrans-2015-052270.433

Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in hiv-positive men who have sex with men. / Ong, Jason Jiat Shern; Fairley, Christopher K; Carroll, Susan; Walker, Sandra Margaret; Chen, Marcus; Read, Timothy Richard; Bradshaw, Catriona; Grulich, Andrew; Kaldor, John Martin; Clarke, Philip.

2015. A166 Poster session presented at World STI & HIV Congress, Brisbane, Australia.

Research output: Contribution to conferencePosterOther

TY - CONF

T1 - Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in hiv-positive men who have sex with men

AU - Ong, Jason Jiat Shern

AU - Fairley, Christopher K

AU - Carroll, Susan

AU - Walker, Sandra Margaret

AU - Chen, Marcus

AU - Read, Timothy Richard

AU - Bradshaw, Catriona

AU - Grulich, Andrew

AU - Kaldor, John Martin

AU - Clarke, Philip

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

U2 - 10.1136/sextrans-2015-052270.433

DO - 10.1136/sextrans-2015-052270.433

M3 - Poster

SP - A166

ER -