Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA.
J Low Genit Tract Dis. 2012 Jul;16(3):275-80. doi: 10.1097/LGT.0b013e31823cde2f.
Anal cancer rates have increased in HIV+ patients. The prevalence of anal intraepithelial neoplasias (AINs) and progression to anal cancer in HIV+ men who have sex with men has been well described, and screening is cost-effective. Our objective was to determine whether anal cancer screening in HIV+ women is cost-effective.
A Markov model analysis of 100 HIV+ women was constructed. All women had a CD4 count less than 200 and were assumed to be on antiretrovirals. Rates of AIN were based on previous studies. Progression rates were extrapolated from previous data on HIV+ men who have sex with men. The 5-year model included 3 screening approaches: none, annual, and biennial. Anoscopy and biopsy were performed after an abnormal cytologic result. Low-grade AIN was followed with repeat cytology, and high-grade AIN was treated surgically. Anal cancer was treated surgically followed by chemotherapy and radiation. Sensitivity analyses (SAs) were performed to account for variable rates of AIN progression, anal cancer mortality, and anal cancer and HIV quality-adjusted life years.
The incremental cost-effectiveness ratio of biennial anal cancer screening compared to no screening was $34,763. Cost-effectiveness was maintained across all assumptions in SA except for decreased progression rate of high-grade AIN to anal cancer.
Biennial anal cancer screening in HIV+ women with CD4 counts less than 200 is cost-effective. Annual screening was not cost-effective, likely because of the slow progression of AIN to anal cancer. Further data on rates of AIN progression in HIV+ women based on CD4 count are needed to determine whether screening is cost-effective in women with higher CD4 counts.
艾滋病病毒（HIV）阳性患者的肛门癌发病率有所增加。HIV 阳性男男性行为者中肛门上皮内瘤变（AIN）的流行情况及其进展为肛门癌已有充分描述，且筛查具有成本效益。我们的目的是确定对 HIV 阳性女性进行肛门癌筛查是否具有成本效益。
对 100 例 HIV 阳性女性进行了马尔可夫模型分析。所有女性的 CD4 计数均<200，并假定正在接受抗逆转录病毒治疗。AIN 发生率基于既往研究。进展率从既往男男性行为 HIV 阳性者的数据中推断得出。5 年模型包括 3 种筛查方法：不筛查、每年筛查和每两年筛查。在细胞学异常结果后进行肛门镜和活检。低级别 AIN 采用重复细胞学检查，高级别 AIN 采用手术治疗。肛门癌采用手术治疗，随后进行化疗和放疗。为了考虑 AIN 进展、肛门癌死亡率以及肛门癌和 HIV 质量调整生命年的可变比率，进行了敏感性分析（SA）。
与不筛查相比，每两年进行一次肛门癌筛查的增量成本效益比为 34763 美元。除了高级别 AIN 进展为肛门癌的比率降低外，在所有假设的敏感性分析中，成本效益均得以维持。
CD4 计数<200 的 HIV 阳性女性每两年进行一次肛门癌筛查具有成本效益。每年筛查不具有成本效益，可能是因为 AIN 进展为肛门癌的速度较慢。需要进一步根据 CD4 计数获得更多关于 HIV 阳性女性 AIN 进展率的数据，以确定在 CD4 计数较高的女性中筛查是否具有成本效益。
