Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in human immunodeficiency virus-negative homosexual and bisexual men

Am J Med. 2000 Jun 1;108(8):634-41. doi: 10.1016/s0002-9343(00)00349-1.


Purpose: 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.

Subjects and methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anus Neoplasms / diagnosis
  • Anus Neoplasms / economics*
  • Anus Neoplasms / prevention & control*
  • Bisexuality*
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / economics*
  • Carcinoma, Squamous Cell / prevention & control*
  • Cost-Benefit Analysis
  • HIV Seronegativity*
  • Health Care Costs*
  • Homosexuality, Male*
  • Humans
  • Life Expectancy
  • Male
  • Markov Chains
  • Mass Screening / economics*
  • Middle Aged
  • Quality-Adjusted Life Years
  • United States