Cost-utility analysis of screening high-risk groups for anal cancer

Karnon, Jonathan; Jones, Ray V. H.; Czoski-Murray, Carolyn; Smith, Kevin

doi:10.1093/pubmed/fdn045

Cited by 36 publications

(29 citation statements)

References 32 publications

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“…In 2007, the New York State Department of Health AIDS Institute issued guidelines supporting cytology screening at baseline and annually in HIV-infected MSM, persons with a history of anogenital condyloma, and HIV-infected women with a history of lower tract genital disease. Annual cytology screening in HIV-infected MSM and biannually in HIV-uninfected MSM was shown to be cost effective in two studies using Markov modeling in the United States, but annual screening of MSM was not found to be cost effective in a United Kingdom study (Goldie, Kuntz, Weinstein, Freedberg, & Palefsky, 2000;Goldie et al, 1999;Karnon, Jones, Czoski-Murray, & Smith, 2008).…”

Section: Frequency Of Screeningmentioning

confidence: 97%

Elements of an Anal Dysplasia Screening Program

Jay

2011

Journal of the Association of Nurses in AIDS Care

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The incidence of anal cancer in HIV-infected men who have sex with men (MSM) is highly elevated compared to the general population, as is the incidence of its precursor lesion, high-grade anal intraepithelial neoplasia (HGAIN). MSM in general and other immunocompromised populations are also at higher risk. Treatment of HGAIN may prevent development of cancer, similar to the decrease in cervical cancers that has occurred since the advent of cervical cancer screening programs in women. Cervical cancer screening tools have been adapted and validated for screening, diagnosis, and treatment of anal HGAIN. Anal cancer screening programs have now been available for more than a decade, although they are not yet standards of care. Incorporating screening procedures into practice depends on the available resources in a particular community. This article discusses the procedures for anal cancer screening including cytology, digital anal rectal examinations, high-resolution anoscopy, and biopsy.

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Section: Frequency Of Screeningmentioning

confidence: 97%

Elements of an Anal Dysplasia Screening Program

Jay

2011

Journal of the Association of Nurses in AIDS Care

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“…In addition to these, the model included health states for HIV progression based on the patient’s CD4 count (i.e., CD4 >500 cells/mm 3 , CD4 between 200–500 cells/mm 3 , and CD4 <200 cells/mm 3 ). Patient CD4 count, rates of HSIL progression or regression, and natural history post initial regression were obtained from the literature or calibrated using a separate natural history model for anal carcinogenesis (Appendix S1.3; Appendix Table T1.1 and T1.2) [2, 9, 19, 29–31]. Our model also considered the possibility of receiving antiretroviral therapy (ART) and the impact of change in CD4 count on anal carcinogenesis.…”

Section: Methodsmentioning

confidence: 99%

“…Cost data were estimated using the Surveillance, Epidemiology, and End Results (SEER) database and Medicare claims (Appendix Table T1.4) as well as obtained from published studies [28, 29, 33]. Health-state utilities (preference-based valuation of quality of life) were identified from the literature (Appendix Table T1.4) [29].…”

Section: Methodsmentioning

confidence: 99%

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Adjuvant HPV vaccination for anal cancer prevention in HIV-positive men who have sex with men: The time is now

Deshmukh

Cantor

Fenwick

et al. 2017

Vaccine

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Importance Outcomes of treating high-grade squamous intraepithelial lesions (HSIL), a precursor to anal cancer, remain uncertain. Emerging evidence shows that post HSIL treatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves the effectiveness of treatment. However, no recommendations exist regarding the use of qHPV vaccine as an adjuvant form of therapy. Our objective was to determine whether post-treatment adjuvant vaccination should be adopted in HIV-infected MSM (individuals at highest risk for anal cancer) on the basis of cost-effectiveness determined using existing evidence or whether future research is needed. Methods We developed a Markov (state-transition) cohort model to assess the cost-effectiveness of post-treatment adjuvant HPV vaccination of 27 years or older HIV-infected MSM. We first estimated cost-effectiveness and then performed value-of-information (VOI) analysis to determine whether future research is required by estimating the expected value of perfect information (EVPI). We also estimated expected value of partial perfect information (EVPPI) to determine what new evidences should have highest priority. Results With the incremental cost-effectiveness ratio (ICER) of $71,937/QALY, “treatment plus vaccination” was the most cost-effective HSIL management strategy using the willingness-to-pay threshold of 100,000/QALY. We found that population-level EVPI for conducting future clinical research evaluating HSIL management approaches was US$12 million (range $6–$20 million). The EVPPI associated with adjuvant qHPV vaccination efficacy estimated in terms of hazards of decreasing HSIL recurrence was $0 implying that additional data from a future study evaluating efficacy of adjuvant qHPV vaccination will not change our policy conclusion that “treatment plus vaccination” was cost-effective. Both the ICER and EVPI were sensitive to HSIL treatment compliance. Conclusion Post-treatment adjuvant qHPV vaccination in HIV-infected MSM aged 27 or above is likely to be cost-effective. Use of adjuvant qHPV vaccination could be considered as a potential strategy to reduce rising anal cancer burden among these high-risk individuals.

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“…High-risk groups considered candidates for screening include both HIV-positive and HIV-negative men who have sex with men (MSM) [2,3] and women who are HIV-positive [4,5]. Although some modeling studies have concluded that anal cytology screening is likely to be cost-effective [6,7,8], groups such as the United States Preventive Services Task Force, the American Cancer Society, the Centers for Disease Control and the Infectious Diseases Society of America do not support routine anal cytology screening [9]. There are no national screening guidelines for anal cancer, and investigators have suggested different abnormal anal cytologic result thresholds for referral of patients with abnormal anal cytology to high-resolution anoscopy (HRA) and directed biopsy [3,10,11].…”

Section: Introductionmentioning

confidence: 99%

Histopathologic Outcomes and Clinical Correlations for High-Risk Patients Screened with Anal Cytology

Zhao¹,

Domfeh²,

Austin³

2012

Acta Cytologica

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Objective: Anal cytologic testing is being increasingly used as a preventive screening test in high-risk populations. We document anal cytology results, correlating HIV test results, and histopathologic follow-up outcomes from a large integrated health system which recently implemented anal screening. Study Design: Anal Pap tests between May 2007 and August 2009 were studied and correlated with HIV test histories and follow-up histopathologic diagnoses. Results: 688 anal cytologic tests were identified with 7.4% reported as unsatisfactory; 72% of anal cytologic tests were abnormal; 91% of patients were HIV positive. The HIV-positive rate and likelihood of high viral load were both significantly greater among patients with abnormal anal cytology than among patients with negative anal cytology, but did not vary significantly among patients with different categories of abnormal anal cytology. For 459 patients with abnormal anal cytology, 198 had anal biopsies. For patients with abnormal anal cytology findings of ASC-US (atypical squamous cells of undetermined significance), LSIL (low-grade squamous intraepithelial neoplasia), ASC-H (atypical squamous cells, cannot exclude high-grade squamous lesion), and HSIL (high-grade squamous intraepithelial neoplasia), histopathologic intraepithelial neoplasia (AIN)2/3 or 2/3+ diagnoses were established in 46.5, 56.6, 65, and 80.8%, respectively. Conclusions: Patients with any level of abnormal anal cytology result are at significant risk of the presence of histopathologically verifiable high-grade anal intraepithelial lesions. More specific markers for identifying patients at highest risk of progression to invasive anal carcinoma are needed.

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Cost-utility analysis of screening high-risk groups for anal cancer

Cited by 36 publications

References 32 publications

Elements of an Anal Dysplasia Screening Program

Elements of an Anal Dysplasia Screening Program

Adjuvant HPV vaccination for anal cancer prevention in HIV-positive men who have sex with men: The time is now

Histopathologic Outcomes and Clinical Correlations for High-Risk Patients Screened with Anal Cytology

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