Goldie S J, Kuntz K M, Weinstein M C, Freedberg K A, Palefsky J M
Department of Health Policy and Management, Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts, USA.
Am J Med. 2000 Jun 1;108(8):634-41. doi: 10.1016/s0002-9343(00)00349-1.
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.
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.
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.
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.
男同性恋者和双性恋男性感染人乳头瘤病毒诱发肛门鳞状上皮内病变及肛门癌的风险更高。我们的目标是评估对这些高危患者进行肛门鳞状上皮内病变筛查的成本效益。
构建马尔可夫模型，以评估在一组假设的男同性恋者和双性恋男性中采用肛门细胞学检查的不同筛查策略。数据来源于前瞻性队列研究、国家数据库、医疗保险报销率及已发表的文献。模型结果包括预期寿命、质量调整预期寿命、终生总成本及增量成本效益比。
每3年进行一次肛门细胞学筛查带来的未贴现预期寿命增加为5.5个月。与不进行筛查相比，每3年进行一次筛查使贴现后的质量调整预期寿命增加1.8个月，每获得一个质量调整生命年（QALY）的成本为7000美元。与每3年进行一次筛查相比，每2年进行一次筛查每获得一个QALY的成本为15100美元。每年进行筛查带来的增量效益少于0.5个质量调整月，每获得一个QALY的增量成本为34800美元。每6个月进行一次筛查与每年进行一次筛查相比几乎没有额外益处（即5天），每获得一个QALY的增量成本为143500美元。
对于男同性恋者和双性恋男性，每2或3年采用肛门细胞学检查筛查肛门鳞状上皮内病变可带来与其他公认的预防性健康措施相当的预期寿命益处，且具有成本效益。
