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Health

Cost-effectiveness of screening and treating anal pre-cancerous … – The Lancet

Kim Martel
Starting distribution HSIL 0.4730

  • Machalek D.A.
  • Jin F.
  • Poynten I.M.
  • et al.
Prevalence and risk factors associated with high-grade anal squamous intraepithelial lesions (HSIL)-AIN2 and HSIL-AIN3 in homosexual men.

No HSIL 0.5270

  • Machalek D.A.
  • Jin F.
  • Poynten I.M.
  • et al.
Prevalence and risk factors associated with high-grade anal squamous intraepithelial lesions (HSIL)-AIN2 and HSIL-AIN3 in homosexual men.

Annual HSIL screening and treatment uptake Screening – control 0.0500 0.0000 0.1000 Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Screening – intervention 0.6000 0.4000 0.8000

  • Poynten I.M.
  • Jin F.
  • Roberts J.M.
  • et al.
The natural history of anal high-grade squamous intraepithelial lesions in gay and bisexual men.

,

  • Machalek D.A.
  • Grulich A.E.
  • Hillman R.J.
  • et al.
The Study of the Prevention of Anal Cancer (SPANC): design and methods of a three-year prospective cohort study.

Treatment – control 0.1000 0.0000 0.2000 Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Treatment – intervention 0.7500 0.5000 1.0000 Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Annual transition probabilities Natural regression from HSIL to no HSIL 0.1870 0.1471 0.2336

  • Poynten I.M.
  • Jin F.
  • Roberts J.M.
  • et al.
The natural history of anal high-grade squamous intraepithelial lesions in gay and bisexual men.

Develop localised cancer from HSIL – control 0.0040 0.0036 0.0044

  • Poynten I.M.
  • Jin F.
  • Roberts J.M.
  • et al.
The natural history of anal high-grade squamous intraepithelial lesions in gay and bisexual men.

,

  • Palefsky J.M.
  • Lee J.Y.
  • Jay N.
  • et al.
Treatment of anal high-grade squamous intraepithelial lesions to prevent anal cancer.

Develop localised cancer from HSIL – intervention 0.0017 0.0015 0.0020

  • Palefsky J.M.
  • Lee J.Y.
  • Jay N.
  • et al.
Treatment of anal high-grade squamous intraepithelial lesions to prevent anal cancer.

Progress from no HSIL to HSIL 0.1306 0.0976 0.1696

  • Poynten I.M.
  • Jin F.
  • Roberts J.M.
  • et al.
The natural history of anal high-grade squamous intraepithelial lesions in gay and bisexual men.

Localised anal cancer detection without screening 0.2000 0.1500 0.2500

  • Ong J.J.
  • Fairley C.K.
  • Carroll S.
  • et al.
Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Regional anal cancer detection without screening 0.2500 0.2000 0.3000

  • Ong J.J.
  • Fairley C.K.
  • Carroll S.
  • et al.
Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Distal anal cancer detection without screening 0.3000 0.2500 0.3500

  • Ong J.J.
  • Fairley C.K.
  • Carroll S.
  • et al.
Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Undetected localised anal cancer progressing to regional anal cancer 0.1000 0.0700 0.1400 Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Undetected regional anal cancer progressing to distal anal cancer 0.1500 0.1000 0.2000 Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Treated localised anal cancer progressing to regional anal cancer 0.0200 0.0024 0.0697 St Vincent’s Hospital, Sydney – Local data Treated regional anal cancer progressing to distal anal cancer 0.0410 0.0108 0.0973 St Vincent’s Hospital, Sydney – Local data Distribution of anal cancer by stage at diagnosis

National Cancer Institute
Anus, anal canal & Anorectum cancer, stage distribution of SEER incidence cases.

Local 0.5293 Regional 0.3472 Distal 0.1234 Annual mortality rate (HIV+) AHOD 2022 – unpublished data age, years 35–39 0.0016  40–44 0.0015  45–49 0.0024  50–54 0.0042  55–59 0.0055  60–64 0.0082  65–69 0.0116  70–74 0.0177 75–79 0.0334 80–84 0.0575 85+ 0.1306 Annual mortality rate (anal cancer)

National Cancer Institute
Anus, anal canal & Anorectum cancer, stage distribution of SEER incidence cases.

Local cancer age, years 35–39 0.0246 40–64 0.0365 65–74 0.0423 75+ 0.0584 Regional cancer age, years 35–39 0.0857 40–64 0.0795 65–74 0.0754 75+ 0.1236 Distal cancer age, years 35–39 0.2318 40–64 0.2302 65–74 0.2585 75+ 0.3717 Transition costs (2020 AUD) HSIL screening

  • Australian Government
Medicare Benefits Schedule.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

 High-risk HPV DNA testing 125 60 250  High-risk HPV mRNA 150 75 300  High HPV 16/18 viral load 152 75 300 Confirmatory high-resolution anoscopy 266 100 500

  • Australian Government
Medicare Benefits Schedule.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

HSIL electrocautery 66.55 30 130

  • Australian Government
Medicare Benefits Schedule.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Workup 1827 900 3600

  • Australian Government
Medicare Benefits Schedule.

Localised cancer treatment 7825 4000 16,000

  • Australian Government
Medicare Benefits Schedule.

,

  • Australian Government
Pharmaceutical Benefits Scheme.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Regional cancer treatment 9014 5000 18,000

  • Australian Government
Medicare Benefits Schedule.

,

  • Australian Government
Pharmaceutical Benefits Scheme.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Distal cancer treatment 14,232 7000 28,000

  • Australian Government
Medicare Benefits Schedule.

,

  • Australian Government
Pharmaceutical Benefits Scheme.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Annual health state costs (2020 AUD) No HSIL 15,228 7500 30,000

  • Lim M.
  • Devine A.
  • Gray R.
  • Kwon J.
  • Hutchinson J.
  • Ong J.J.
Lifetime cost of HIV management in Australia: an economic model.

HSIL 15,228 7500 30,000

  • Lim M.
  • Devine A.
  • Gray R.
  • Kwon J.
  • Hutchinson J.
  • Ong J.J.
Lifetime cost of HIV management in Australia: an economic model.

Undetected localised cancer 15,228 7500 30,000

  • Lim M.
  • Devine A.
  • Gray R.
  • Kwon J.
  • Hutchinson J.
  • Ong J.J.
Lifetime cost of HIV management in Australia: an economic model.

Undetected regional cancer 15,228 7500 30,000

  • Lim M.
  • Devine A.
  • Gray R.
  • Kwon J.
  • Hutchinson J.
  • Ong J.J.
Lifetime cost of HIV management in Australia: an economic model.

Undetected distal cancer 15,228 7500 30,000

  • Lim M.
  • Devine A.
  • Gray R.
  • Kwon J.
  • Hutchinson J.
  • Ong J.J.
Lifetime cost of HIV management in Australia: an economic model.

Treated localised cancer 17,540 9000 35,000

  • Australian Government
Medicare Benefits Schedule.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Treated regional cancer 17,467 9000 35,000

  • Australian Government
Medicare Benefits Schedule.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Treated distal cancer 16,670 9000 35,000

  • Australian Government
Medicare Benefits Schedule.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Health state utility No HSIL/HSIL/Undetected localised cancer 0.75 0.6 0.9 SPANC – unpublished data Undetected regional cancer 0.66 0.5 0.75

  • Djalalov S.
  • Rabeneck L.
  • Tomlinson G.
  • Bremner K.E.
  • Hilsden R.
  • Hoch J.S.
A review and meta-analysis of colorectal cancer utilities.

Undetected distal cancer 0.52 0.4 0.65

  • Djalalov S.
  • Rabeneck L.
  • Tomlinson G.
  • Bremner K.E.
  • Hilsden R.
  • Hoch J.S.
A review and meta-analysis of colorectal cancer utilities.

Remission 0.71 0.6 0.8

  • Ong J.J.
  • Fairley C.K.
  • Carroll S.
  • et al.
Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV.

Disutility Screening for HSIL 0.001 0.0005 0.002

  • Paracha N.
  • Abdulla A.
  • MacGilchrist K.S.
Systematic review of health state utility values in metastatic non-small cell lung cancer with a focus on previously treated patients.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Treating HSIL 0.005 0.001 0.040

  • Paracha N.
  • Abdulla A.
  • MacGilchrist K.S.
Systematic review of health state utility values in metastatic non-small cell lung cancer with a focus on previously treated patients.

, Expert opinion

Where we were lacking data on which to base a model parameter, we relied on the clinical (JJO, RJH, GH), epidemiologic (IMP, FJ, AG, DCB), and health economic (QC, JJO, KH, AN, DCB) expertise of our authorship group to establish an expert opinion.

Treating anal cancer 0.007 0.003 0.012

  • Paracha N.
  • Abdulla A.
  • MacGilchrist K.S.
Systematic review of health state utility values in metastatic non-small cell lung cancer with a focus on previously treated patients.