Is anal cancer screening in MSM with HIV worth the buck?

Screening for anal cancer among men who have sex with men (MSM) with HIV aged ≥35 years is cost-effective, according to a recent study. However, there is a need for value-based prioritization strategies to improve screening use.

In base-case analysis, screening initiation at age 35 years or older using cytology dominated that at aged 40 and 45 years or older, with incremental cost-effectiveness ratios (ICERs) ranging from $87,731 for a quadrennial interval to $350,100 for an annual interval.

The comparative analysis revealed the following cost-effective strategies: quadrennial human papilloma virus (HPV)16, quadrennial HPV16/18, triennial HPV16/18, triennial high-risk (hr)HPV, biennial HPV16/18, biennial hrHPV, annual cytology with hrHPV triage, and annual hrHPV. Their ICERs ranged from $81,341 to $2,510,847. 

In the harm-to-benefit analysis, the most efficient HRA use was achieved by triage options.

Finally, sensitivity analysis showed reduced ICERs for newly eligible MSM with HIV. For those aged 35 years, the ICERs for cytology ranged from $70,750 (quadrennial) to $223,895 (annual).

These findings, however, are not generalizable to other high-risk populations, according to the authors.

This study employed a microsimulation model using the ANCHOR trial and published literature. Interventions included cytology alone and HPV testing. The authors then estimated the ICERs of dollars per quality-adjusted life-year and the tradeoff of harms vs benefits.