Cost-effectiveness of surveillance strategies after treatment for high-grade anal dysplasia in high-risk patients.
Cost-effectiveness of surveillance strategies after treatment for high-grade anal dysplasia in high-risk patients.
复制标题
高危患者重度肛门发育不良治疗后监测策略的成本效益。
DOI：
10.1097/olq.0b013e31827f4fe9
复制
发表时间：
2013
影响因子：
3.1
通讯作者：
Kim,Jane
中科院分区：
文献类型：
--
作者：
Assoumou,SabrinaA;Mayer,KennethH;Panther,Lori;Linas,BenjaminP;Kim,Jane
肛门癌是人类免疫缺陷病毒（HIV）感染的男性患者最常见的癌症之一.目前，对接受过高度上皮内瘤变（HGAIN）治疗的男男性行为者（MSM）的艾滋病毒感染者治疗后监测尚无共识，肛门癌的可能前兆。本研究的目的是评估一系列策略的成本效益，肛门癌监测艾滋病毒感染的男男性接触者先前治疗HGAIN.MethodsWe开发了一个马尔可夫模型，项目质量-调整后的预期寿命，终身成本，和增量成本效益比的5个战略，使用高分辨率肛门镜检查（HRA）和/或肛门细胞学检测后treatment.ResultsPerforming HRA单独在6个月和12个月的访问与成本效益比为4446美元，每质量调整后的生命年获得。相比之下，在两次访视时结合HRA和肛门细胞学检查提供了更大的健康益处，每获得一个质量调整生命年的成本为17，373美元。我们的研究结果在包括患者免疫抑制水平在内的许多情况和假设下都是稳健的。结果是最敏感的测试特性和成本，以及正常的HGAIN和HGAIN癌症的进展率。ConclusionsOur结果表明，结合HRA和肛门细胞学检查在6个月和12个月可能是一个具有成本效益的监测策略HGAIN治疗后，HIV感染的男男性行为者。
BackgroundAnal cancer is one of the most common cancers affecting human immunodeficiency virus (HIV)–infected male patients. Currently, there is no consensus on posttreatment surveillance of HIV-infected men who have sex with men (MSM) who have been treated for high-grade intraepithelial neoplasia (HGAIN), the likely precursor to anal cancer.ObjectiveThe aim of this study was to assess the cost-effectiveness of a range of strategies for anal cancer surveillance in HIV-infected MSM previously treated for HGAIN.MethodsWe developed a Markov model to project quality-adjusted life expectancy, lifetime costs, and the incremental cost-effectiveness ratios of 5 strategies using high-resolution anoscopy (HRA) and/or anal cytology testing after treatment.ResultsPerforming HRA alone at 6-and 12-month visits was associated with a cost-effectiveness ratio of $4446 per quality-adjusted life year gained. In comparison, combined HRA and anal cytology at both visits provided greater health benefit at a cost of $17,373 per quality-adjusted life year gained. Our results were robust over a number of scenarios and assumptions including patients’ level of immunosuppression. Results were most sensitive to test characteristics and cost, as well as progression rates of normal to HGAIN and HGAIN to cancer.ConclusionsOur results suggest that combined HRA and anal cytology at 6 and 12 months may be a cost-effective surveillance strategy after treatment of HGAIN in HIV-infected MSM.