OBJECTIVE: To assess the cost-effectiveness of high-resolution anoscopy (HRA), anal cytology, and anal human papillomavirus (HPV) detection in screening for histologic high-grade anal intraepithelial neoplasia (AIN 2/3) in HIV-positive MSM. DESIGN: Participants were 401 HIV-positive MSM who were screened for anal cancer in a tertiary care HIV clinic. METHODS: A decision analytical model was used to determine the cost-effectiveness of three anal cancer screening strategies: the direct use of HRA; HRA only if anal cytology was abnormal; and HRA only if oncogenic HPV was present. The model included the use of different thresholds for abnormal cytology and also combined cytology and HPV testing. The outcome was the number of AIN 2/3 cases detected. Costs were estimated from institutional data and sensitivity/specificity of cytology and HPV tests were obtained from the screening study. RESULTS: The costs ($ US) per procedure for HRA, cytology, and HPV testing were $193, $90, and $95, respectively. The direct use of HRA was the most cost-effective strategy. It detected 98 individuals with AIN 2/3 and had a cost-effectiveness of $809 per AIN 2/3 case detected. Using probabilistic sensitivity analysis, three other strategies had similar costs per case detected and might be as cost-effective as HRA. CONCLUSION: In HIV-infected MSM, the direct use of HRA is the most cost-effective strategy for detecting AIN 2/3. The higher cost per use for HRA was offset by the high sensitivity and low specificity of HPV and cytology testing.
OBJECTIVE: To assess the cost-effectiveness of high-resolution anoscopy (HRA), anal cytology, and anal human papillomavirus (HPV) detection in screening for histologic high-grade anal intraepithelial neoplasia (AIN 2/3) in HIV-positive MSM. DESIGN:Participants were 401 HIV-positive MSM who were screened for anal cancer in a tertiary care HIV clinic. METHODS: A decision analytical model was used to determine the cost-effectiveness of three anal cancer screening strategies: the direct use of HRA; HRA only if anal cytology was abnormal; and HRA only if oncogenic HPV was present. The model included the use of different thresholds for abnormal cytology and also combined cytology and HPV testing. The outcome was the number of AIN 2/3 cases detected. Costs were estimated from institutional data and sensitivity/specificity of cytology and HPV tests were obtained from the screening study. RESULTS: The costs ($ US) per procedure for HRA, cytology, and HPV testing were $193, $90, and $95, respectively. The direct use of HRA was the most cost-effective strategy. It detected 98 individuals with AIN 2/3 and had a cost-effectiveness of $809 per AIN 2/3 case detected. Using probabilistic sensitivity analysis, three other strategies had similar costs per case detected and might be as cost-effective as HRA. CONCLUSION: In HIV-infected MSM, the direct use of HRA is the most cost-effective strategy for detecting AIN 2/3. The higher cost per use for HRA was offset by the high sensitivity and low specificity of HPV and cytology testing.
Authors: Vikrant V Sahasrabuddhe; Philip E Castle; Stephen Follansbee; Sylvia Borgonovo; Diane Tokugawa; Lauren M Schwartz; Thomas S Lorey; Brandon J LaMere; Julia C Gage; Barbara Fetterman; Sean Boyle; Mark Sadorra; Scott Dahai Tang; Teresa M Darragh; Nicolas Wentzensen Journal: J Infect Dis Date: 2012-11-16 Impact factor: 5.226
Authors: Carmen Hidalgo-Tenorio; Jessica Ramírez-Taboada; Concepción Gil-Anguita; Javier Esquivias; Mohamed Omar-Mohamed-Balgahata; Antonio SamPedro; Miguel Lopez-Ruz; Juan Pasquau Journal: AIDS Res Ther Date: 2017-07-18 Impact factor: 2.250
Authors: Emily A Burger; Michael A Dyer; Stephen Sy; Joel M Palefsky; Alexandra de Pokomandy; François Coutlee; Michael J Silverberg; Jane J Kim Journal: J Acquir Immune Defic Syndr Date: 2018-09-01 Impact factor: 3.731