University of Toronto, Toronto General Hospital, Canada.
AIDS. 2011 Mar 13;25(5):635-42. doi: 10.1097/QAD.0b013e3283434594.
To assess the cost-effectiveness of high-resolution anoscopy (HRA), anal cytology, and anal human papillomavirus (HPV) detection in screening for histologic high-grade anal intraepithelial neoplasia (AIN 2/3) in HIV-positive MSM.
Participants were 401 HIV-positive MSM who were screened for anal cancer in a tertiary care HIV clinic.
A decision analytical model was used to determine the cost-effectiveness of three anal cancer screening strategies: the direct use of HRA; HRA only if anal cytology was abnormal; and HRA only if oncogenic HPV was present. The model included the use of different thresholds for abnormal cytology and also combined cytology and HPV testing. The outcome was the number of AIN 2/3 cases detected. Costs were estimated from institutional data and sensitivity/specificity of cytology and HPV tests were obtained from the screening study.
The costs ($ US) per procedure for HRA, cytology, and HPV testing were $193, $90, and $95, respectively. The direct use of HRA was the most cost-effective strategy. It detected 98 individuals with AIN 2/3 and had a cost-effectiveness of $809 per AIN 2/3 case detected. Using probabilistic sensitivity analysis, three other strategies had similar costs per case detected and might be as cost-effective as HRA.
In HIV-infected MSM, the direct use of HRA is the most cost-effective strategy for detecting AIN 2/3. The higher cost per use for HRA was offset by the high sensitivity and low specificity of HPV and cytology testing.
评估高分辨率肛门镜检查（HRA）、肛门细胞学检查和肛门人乳头瘤病毒（HPV）检测在筛查 HIV 阳性男男性行为者（MSM）组织学高级别肛门上皮内瘤变（AIN 2/3）中的成本效益。
参与者为 401 名在三级保健 HIV 诊所筛查肛门癌的 HIV 阳性 MSM。
使用决策分析模型来确定三种肛门癌筛查策略的成本效益：直接使用 HRA；如果肛门细胞学异常，则仅使用 HRA；如果存在致癌 HPV，则仅使用 HRA。该模型包括使用不同的细胞学异常阈值，并且还结合了细胞学和 HPV 检测。结果是检测到的 AIN 2/3 病例数。成本根据机构数据估算，细胞学和 HPV 检测的敏感性/特异性从筛查研究中获得。
HRA、细胞学和 HPV 检测的每例程序费用（美元）分别为 193 美元、90 美元和 95 美元。直接使用 HRA 是最具成本效益的策略。它检测到 98 名 AIN 2/3 患者，每例 AIN 2/3 病例的成本效益为 809 美元。使用概率敏感性分析，另外三种策略的每例病例检测成本相似，可能与 HRA 一样具有成本效益。
在感染 HIV 的 MSM 中，直接使用 HRA 是检测 AIN 2/3 的最具成本效益的策略。HRA 每次使用的成本较高，但 HPV 和细胞学检测的敏感性高而特异性低，因此得到了弥补。
