Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in human immunodeficiency virus-negative homosexual and bisexual men.
OBJECTIVE
Homosexual and bisexual men are at an increased risk for human papillomavirus-induced squamous intraepithelial lesions and cancer of the anus. Our objective was to estimate the cost-effectiveness of screening for anal squamous intraepithelial lesions in these high-risk patients.


METHODS
A Markov model was developed to evaluate alternative screening strategies using anal cytology in a hypothetical cohort of homosexual and bisexual men. Data were obtained from prospective cohort studies, national databases, Medicare reimbursement rates, and the published literature. Model outcomes included life expectancy, quality-adjusted life expectancy, total lifetime costs, and incremental cost-effectiveness ratios.


RESULTS
The undiscounted life expectancy gain associated with anal cytology screening every 3 years was 5.5 months. Compared with no screening, screening every 3 years increased the discounted quality-adjusted life expectancy by 1.8 months and cost $7,000 per quality-adjusted life year (QALY) gained. Screening every 2 years cost $15,100 per QALY gained compared with screening every 3 years. Annual screening provided incremental benefits of less than 0.5 quality-adjusted months and had an incremental cost of $34,800 per QALY gained. Screening every 6 months provided little additional benefit (i.e, 5 days) over that of annual screening and had an incremental cost of $143,500 per QALY gained.


CONCLUSIONS
In homosexual and bisexual men, screening every 2 or 3 years for anal squamous intraepithelial lesions with anal cytology would provide life-expectancy benefits comparable with other accepted preventive health measures, and would be cost-effective.
Goldie
S J
SJ
Department of Health Policy and Management, Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts, USA.
Kuntz
K M
KM
Weinstein
M C
MC
Freedberg
K A
KA
Palefsky
J M
JM
D000328:Adult; D001005:Anus Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control*; D001727:Bisexuality; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D018023:HIV Seronegativity; D017048:Health Care Costs; D018451:Homosexuality, Male; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D014481:United States