Cost-effectiveness of screening and treating anal pre-cancerous lesions among gay, bisexual and other men who have sex with men living with HIV.

Anal Cancer HIV High-grade squamous intra-epithelial Men

Journal

The Lancet regional health. Western Pacific
ISSN: 2666-6065
Titre abrégé: Lancet Reg Health West Pac
Pays: England
ID NLM: 101774968

Informations de publication

Date de publication:
Mar 2023
Historique:
received: 18 10 2022
revised: 02 12 2022
accepted: 19 12 2022
entrez: 14 2 2023
pubmed: 15 2 2023
medline: 15 2 2023
Statut: epublish

Résumé

Gay, bisexual and other men who have sex with men (GBM) living with HIV have a substantially elevated risk of anal cancer (85 cases per 100,000 person-years vs 1-2 cases per 100,000 person-years in the general population). The precursor to anal cancer is high-grade squamous intraepithelial lesion (HSIL). Findings regarding the cost-effectiveness of HSIL screening and treatment in GBM are conflicting. Using recent data on HSIL natural history and treatment effectiveness, we aimed to improve upon earlier models. We developed a Markov cohort model populated using observational study data and published literature. Our study population was GBM living with HIV aged ≥35 years. We used a lifetime horizon and framed our model on the Australian healthcare perspective. The intervention was anal HSIL screening and treatment. Our primary outcome was the incremental cost-effectiveness ratio (ICER) as cost per quality-adjusted life-year (QALY) gained. Anal cancer incidence was estimated to decline by 44-70% following implementation of annual HSIL screening and treatment. However, for the most cost-effective screening method assessed, the ICER relative to current practice, Australian Dollar (AUD) 135,800 per QALY gained, remained higher than Australia's commonly accepted willingness-to-pay threshold of AUD 50,000 per QALY gained. In probabilistic sensitivity analyses, HSIL screening and treatment had a 20% probability of being cost-effective. When the sensitivity and specificity of HSIL screening were enhanced beyond the limits of current technology, without an increase in the cost of screening, ICERs improved but were still not cost-effective. Cost-effectiveness was achieved with a screening test that had 95% sensitivity, 95% specificity, and cost ≤ AUD 24 per test. Establishing highly sensitive and highly specific HSIL screening methods that cost less than currently available techniques remains a research priority. No specific funding was received for this analysis.

Sections du résumé

Background UNASSIGNED
Gay, bisexual and other men who have sex with men (GBM) living with HIV have a substantially elevated risk of anal cancer (85 cases per 100,000 person-years vs 1-2 cases per 100,000 person-years in the general population). The precursor to anal cancer is high-grade squamous intraepithelial lesion (HSIL). Findings regarding the cost-effectiveness of HSIL screening and treatment in GBM are conflicting. Using recent data on HSIL natural history and treatment effectiveness, we aimed to improve upon earlier models.
Methods UNASSIGNED
We developed a Markov cohort model populated using observational study data and published literature. Our study population was GBM living with HIV aged ≥35 years. We used a lifetime horizon and framed our model on the Australian healthcare perspective. The intervention was anal HSIL screening and treatment. Our primary outcome was the incremental cost-effectiveness ratio (ICER) as cost per quality-adjusted life-year (QALY) gained.
Findings UNASSIGNED
Anal cancer incidence was estimated to decline by 44-70% following implementation of annual HSIL screening and treatment. However, for the most cost-effective screening method assessed, the ICER relative to current practice, Australian Dollar (AUD) 135,800 per QALY gained, remained higher than Australia's commonly accepted willingness-to-pay threshold of AUD 50,000 per QALY gained. In probabilistic sensitivity analyses, HSIL screening and treatment had a 20% probability of being cost-effective. When the sensitivity and specificity of HSIL screening were enhanced beyond the limits of current technology, without an increase in the cost of screening, ICERs improved but were still not cost-effective. Cost-effectiveness was achieved with a screening test that had 95% sensitivity, 95% specificity, and cost ≤ AUD 24 per test.
Interpretation UNASSIGNED
Establishing highly sensitive and highly specific HSIL screening methods that cost less than currently available techniques remains a research priority.
Funding UNASSIGNED
No specific funding was received for this analysis.

Identifiants

DOI: 10.1016/j.lanwpc.2022.100676 PMID: 36785857 PMC: PMC9918792
pubmed: 36785857
doi: 10.1016/j.lanwpc.2022.100676
pii: S2666-6065(22)00291-7
pmc: PMC9918792
doi:

Types de publication

Journal Article

Langues

eng

Pagination

100676

Informations de copyright

© 2022 The Author(s).

Déclaration de conflit d'intérêts

None to declare.

Références

PLoS One. 2012;7(8):e38334
pubmed: 22912660
BMC Public Health. 2013 Oct 09;13:946
pubmed: 24107134
Int J Cancer. 2009 May 15;124(10):2375-83
pubmed: 19189402
Int J Cancer. 2009 Apr 1;124(7):1626-36
pubmed: 19115209
Lancet Oncol. 2013 Apr;14(4):346-53
pubmed: 23499546
Int J Colorectal Dis. 2021 Feb;36(2):213-226
pubmed: 32979069
N Engl J Med. 2011 Oct 27;365(17):1576-85
pubmed: 22029979
Lancet Infect Dis. 2018 Feb;18(2):198-206
pubmed: 29158102
AIDS. 2017 Jun 1;31(9):1303-1311
pubmed: 28323757
Med Care. 2004 Sep;42(9):851-9
pubmed: 15319610
Clin Oncol (R Coll Radiol). 2015 Dec;27(12):700-7
pubmed: 26382849
Lancet Oncol. 2019 Mar;20(3):394-407
pubmed: 30795950
JAMA. 1999 May 19;281(19):1822-9
pubmed: 10340370
Clin Infect Dis. 2021 Jun 15;72(12):2154-2163
pubmed: 32266940
Med J Aust. 2008 Jan 7;188(1):26-8
pubmed: 18205559
Clin Infect Dis. 2021 Mar 1;72(5):853-861
pubmed: 32342984
Int J Cancer. 2021 Jan 1;148(1):38-47
pubmed: 32621759
Health Qual Life Outcomes. 2018 Sep 12;16(1):179
pubmed: 30208899
HIV Med. 2002 Jan;3(1):28-36
pubmed: 12059948
Health Technol Assess. 2010 Nov;14(53):iii-iv, ix-x, 1-101
pubmed: 21083999
Med Decis Making. 2014 Aug;34(6):809-18
pubmed: 24903121
Papillomavirus Res. 2016 Dec;2:97-105
pubmed: 29074193
N Engl J Med. 2022 Jun 16;386(24):2273-2282
pubmed: 35704479
Radiat Oncol. 2014 May 13;9:113
pubmed: 24886574
Med Care. 1992 Jun;30(6):473-83
pubmed: 1593914
J Int AIDS Soc. 2016 Mar 01;19(1):20514
pubmed: 26942721
Pharmacoeconomics. 2001;19(11):1103-9
pubmed: 11735677
J Health Econ. 2002 Mar;21(2):271-92
pubmed: 11939242
Cancer. 2017 Dec 1;123(23):4709-4719
pubmed: 28950043
BMC Gastroenterol. 2016 Apr 06;16:46
pubmed: 27048435
J Public Health (Oxf). 2008 Sep;30(3):293-304
pubmed: 18559368

Auteurs

Qinglu Cheng (Q)

Kirby Institute, University of New South Wales, Sydney, Australia.

I Mary Poynten (IM)

Kirby Institute, University of New South Wales, Sydney, Australia.

Fengyi Jin (F)

Kirby Institute, University of New South Wales, Sydney, Australia.

Andrew Grulich (A)

Kirby Institute, University of New South Wales, Sydney, Australia.

Jason J Ong (JJ)

Central Clinical School, Monash University, Melbourne, Australia.
London School of Hygiene and Tropical Medicine, London, UK.
Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.

Richard J Hillman (RJ)

Kirby Institute, University of New South Wales, Sydney, Australia.
Dysplasia and Anal Cancer Services, St Vincent's Hospital, Sydney, Australia.

George Hruby (G)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.
University of Sydney, Sydney, Australia.
Genesis Cancer Care, Sydney, Australia.

Kirsten Howard (K)

University of Sydney, Sydney, Australia.

Anthony Newall (A)

School of Population Health, University of New South Wales, Sydney, Australia.

David C Boettiger (DC)

Kirby Institute, University of New South Wales, Sydney, Australia.
Institute for Health and Aging, University of California, San Francisco, USA.
Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

Classifications MeSH