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Type: Journal article
Title: Cost-utility analysis of screening high-risk groups for anal cancer
Author: Karnon, J.
Jones, R.
Czoski-Murray, C.
Smith, K.
Citation: Journal of Public Health (Print Edition), 2008; 30(3):293-304
Publisher: Oxford University Press
Issue Date: 2008
ISSN: 1741-3842
Statement of
Jonathan Karnon, Roy Jones, Carolyn Czoski-Murray, Kevin J. Smith
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.
Keywords: cancer; economics; screening
RMID: 0020082729
DOI: 10.1093/pubmed/fdn045
Appears in Collections:Public Health publications

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