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Article << Previous     |     Next >>   Contents Vol 9(6)

The cost-effectiveness of screening for anal cancer in men who have sex with men: a systematic review

Kirsten Howard A

Sydney School of Public Health, Screening and Test Evaluation Program, University of Sydney, Sydney, NSW 2006, Australia. Email: kirsten.howard@sydney.edu.au

Sexual Health 9(6) 610-619 http://dx.doi.org/10.1071/SH12017
Submitted: 7 February 2012  Accepted: 3 April 2012   Published: 10 August 2012
 
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Abstract

Anal cancer is a relatively rare neoplasm, related to human papillomavirus (HPV), with an incidence that does not warrant general screening. However, as many cases occur in identifiable high-risk populations, targeting these groups may be cost-effective. Screening for anal cancer in men who have sex with men (MSM) may be appropriate, given their elevated risk of anal cancer. Examining existing cost-effectiveness analyses can help inform the design and conduct of future clinical and economic studies.

A review of the literature was performed using three databases to identify studies that assessed the cost-effectiveness of anal cancer screening in MSM. Five analyses were identified: four modelled the cost-effectiveness of cytological screening over a patient’s lifetime, and estimated final health outcomes as survival or quality adjusted survival. The fifth presented a decision analysis with intermediate health outcomes only and did not extrapolate to longer-term health outcomes.

Several factors influenced the incremental cost-effectiveness ratios. These factors were related to a paucity of primary data and included: availability of longer-term epidemiological and natural history data; availability of utility-based quality of life data from an appropriate respondent population; appropriate resource use information; and availability of information on screening adherence.

There is considerable uncertainty in model results: analyses from the United States suggest screening is almost always cost-effective; analyses from the United Kingdom suggest that screening is unlikely to be cost-effective. Uncertainty is primarily driven by data paucity; by summarising key uncertainties in existing models, this review can inform the design and conduct of future studies.

Additional keywords: economics, human papillomavirus, long-term health outcomes, modelling.


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