Introduction The optimal screening strategy for early anal cancer detection in men who have sex with men (MSM) living with HIV is unknown.
Methods We estimated the cost-effectiveness of regular anal examinations to screen for anal cancer in HIV-positive men 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 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 years. The incremental discounted, QALYs gained ranged from 0.02 for 4 yearly screening to 0.03 for annual screening of men aged ≥50 years. Screening of men aged ≥50 years generated ICERs of $29,760 per QALY gained (for screening every 4 years), $32,222 (every 3 years), and $45,484 (every 2 years). Uncertainty for ICERs were most influenced by the cost (financially and decrease in quality of life) from a false positive result, specificity of the anal examination, the probability of detection outside a screening program and the discount rate.
Conclusion In settings where anal cytology for screening precursors of anal cancer is not available, screening for anal cancer by incorporating regular anal examinations into routine HIV care for MSM aged ≥50 years is most likely to be cost-effective by conventional standards.
Disclosure of interest statement This project was funded by a program grant from the Australian National Health and Medical Research Council.