Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV
Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV
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DOI：
10.7448/ias.19.1.20514
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发表时间：
2016-03-01
影响因子：
6
通讯作者：
Clarke, Philip
中科院分区：
文献类型：
--
作者：
Ong, Jason J.;Fairley, Christopher K.;Clarke, Philip
简介：患有艾滋病毒的男男性行为者（MSM）的肛门癌是一个重要问题，但对于如何筛查这种癌症没有一致的指导方针。在设置与肛门细胞学筛查是不可用的，定期肛门检查已提出了一些准则，但其成本效益是unknown.Methods：我们的目标是估计定期肛门检查的成本效益，以筛选肛门癌的HIV阳性男男性接触者生活在澳大利亚使用概率马尔可夫模型。数据来源基于医学文献和在澳大利亚接受年度肛门检查的HIV阳性MSM的临床试验。计算有效性的主要结果指标是未贴现和贴现（3%）的生命周期成本、获得的生命年、获得的质量调整生命年（QALY）和增量成本效益比（ICER）。基础病例分析估计，肛门癌筛查和管理的平均费用从不筛查的195美元到1美元不等，对50岁以上的男性进行终身年度筛查的费用为915英镑。对年龄≥ 50岁的男性进行筛查，每获得一个质量调整生命年的ICER分别为29，760美元（每四年筛查一次）、32，222美元（每三年）和45，484美元（每两年）。ICER的不确定性主要受成本的影响（经济和生活质量下降）从一个假阳性结果，肛门癌的进展率，肛门检查的特异性，检测的概率以外的筛选程序和折扣率。结论：通过将定期肛门检查纳入50岁男男性接触者的常规艾滋病毒护理来筛查肛门癌最有可能是成本-以常规标准来看，鉴于肛门巴氏涂片检查在许多临床环境中还没有广泛应用，应该对感染艾滋病毒的男男性行为者进行定期肛门检查，以早期发现肛门癌。
Introduction: Anal cancer in men who have sex with men (MSM) living with HIV is an important issue but there are no consistent guidelines for how to screen for this cancer. In settings where screening with anal cytology is unavailable, regular anal examinations have been proposed in some guidelines but their cost-effectiveness is unknown.Methods: Our objective was to estimate the cost-effectiveness of regular anal examinations to screen for anal cancer in HIV-positive 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 for calculating effectiveness 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. Screening of men aged >= 50 generated ICERs of $29,760 per QALY gained (for screening every four years), $32,222 (every three years) and $45,484 (every two years). Uncertainty for ICERs was mostly influenced by the cost (financially and decrease in quality of life) from a false-positive result, progression rate of anal cancer, specificity of the anal examination, the probability of detection outside a screening program and the discount rate.Conclusions: Screening for anal cancer by incorporating regular anal examinations into routine HIV care for MSM aged] 50 is most likely to be cost-effective by conventional standards. Given that anal pap smears are not widely available yet in many clinical settings, regular anal exams for MSM living with HIV to detect anal cancer earlier should be implemented.