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. 2016 Jun 27:16:206.
doi: 10.1186/s12913-016-1442-2.

Cost-effectiveness analysis of anal cancer screening in women with cervical neoplasia in British Columbia, Canada

I Cromwell  1   2 , M Gaudet  3   4 , S J Peacock  5   6   7 , C Aquino-Parsons  3
Affiliations

Cost-effectiveness analysis of anal cancer screening in women with cervical neoplasia in British Columbia, Canada

I Cromwell et al. BMC Health Serv Res. .

Abstract

Background: Precursors to anal squamous cell carcinoma may be detectable through screening; however, the literature suggests that population-level testing is not cost-effective. Given that high-grade cervical neoplasia (CIN) is associated with an increased risk of developing anal cancer, and in light of changing guidelines for the follow-up and management of cervical neoplasia, it is worthwhile to examine the costs and effectiveness of an anal cancer screening program delivered to women with previously-detected CIN.

Methods: A model of anal cancer screening and treatment was constructed, to estimate the cost-effectiveness of a population of CIN II/III+ women who were screened using anal cytology vs. one that received no anal cancer screening. Costs were based on Canadian estimates, and survival was based on estimates taken from the scientific literature. Effectiveness was measured in terms of life years gained (LYG) and quality-adjusted life years (QALYs). The model was run for 50 cycles, with each cycle representing one year.

Results: Incremental cost (screened vs. unscreened) was $82.17 per woman in the model. Incremental effectiveness was 0.004 LYG, and was equivalent to zero in terms of QALY. An ICER of $20,561/LYG was calculated, while no meaningful incremental cost-effectiveness ratio (ICER) could be calculated for quality-adjusted survival.

Conclusion: Our analysis suggests that anal cancer screening is cost-effective in terms of overall survival in women with a previous diagnosis of CIN II or CIN III as part of regular follow-up, but may not contribute meaningfully-different quality-adjusted survival due to the adverse effects of screening-related interventions.

Keywords: Anal cancer; Cervical neoplasia; Cost-effectiveness; Screening.

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Figures

Fig. 1
Fig. 1
Health State Transition Model Schematic. a Pre-symptomatic phase, Screening Arm; b Pre-Symptomatic phase, Comparator Arm; c Cancer survival phase, Both Arms
Fig. 2
Fig. 2
Incremental Cost-Effectiveness Plane for 10,000 Bootstrapped ICERs. a Cost/Life Year Gained (LYG); b Cost/quality-adjusted life year (QALY)
Fig. 3
Fig. 3
Cost-Effectiveness Acceptability Curves for Anal Cancer Screening. a Cost/Life Year Gained (LYG); b Cost/quality-adjusted life year (QALY)
Fig. 4
Fig. 4
Selected Results of Univariate Sensitivity Analysis. Baseline ICER = $20,562/LYG
See this image and copyright information in PMC

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