Cost-utility analysis of screening high-risk groups for anal cancer

Jonathan Karnon, Roy Jones, Carolyn Czoski-Muray, Kevin J. Smith

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Objectives

Cost-utility analysis of screening for anal cancer in high-risk groups from a UK perspective.

Methods

Criteria for the assessment of screening programmes were combined in a Markov model representing the natural history of anal cancer and HIV infection in the UK population of men who have sex with men (MSM). Alternative screening programmes were overlaid on the natural history model to evaluate their impact. The model was populated using data derived from a systematic review of the literature, and calibrated probabilistically to represent joint uncertainty in the input parameters.

Results

Reference case results showed screening is unlikely to be cost-effective. Sensitivity analyses identified two important parameters: regression from low-grade anal intra-epithelial neoplasia (AIN) and utility effects. Increased AIN regression rates resulted in a minimum incremental cost per QALY gained of £39 405, whereas a best case scenario reduced the ratio to £20 996.

Conclusions

There are major areas of uncertainty. New analyses of existing primary data, undertaken specifically to inform regression rates may usefully update key parameters at little additional cost. If these analyses increase the likelihood that screening is cost-effective, further studies of the utility effects of treatment for high-grade AIN, and potential screening attendance rates may be justified.
Original languageEnglish
Pages (from-to)293-304
Number of pages12
JournalJournal of Public Health
Volume30
Issue number3
DOIs
Publication statusPublished - 2008
Externally publishedYes

Keywords

  • cancer
  • economics
  • screening

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  • Research Output

    • 34 Citations
    • 1 Article

    Erratum: Cost-utility analysis of screening high risk groups for anal cancer

    Karnon, J., Jones, R., Czoski-Muray, C. & Smith, K. J., Mar 2009, In : Journal of Public Health. 31, 1, p. 194

    Research output: Contribution to journalArticle

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