Evidence map›Paper›PMID 26942721›Full record

ArticleJournal of the International AIDS Society2016

Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV.

Jason J Ong, Christopher K Fairley, Susan Carroll, Sandra Walker, Marcus Chen, Tim Read, Andrew Grulich, Catriona Bradshaw, John Kaldor, Philip Clarke

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the International AIDS Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed
5.3field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 49 citations in OpenAlex.

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  14. Canadian family physician Medecin de famille canadien · 2019
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  15. Educational implications of changing the guidelines for the digital rectal examination.Canadian family physician Medecin de famille canadien · 2019
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 1 country.

Jason J OngSexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Christopher K FairleyMelbourne Sexual Health Centre, Alfred Health, Carlton, Australia.
Susan CarrollChris O'Brien Lifehouse, Camperdown, Australia.
Sandra WalkerMelbourne Sexual Health Centre, Alfred Health, Carlton, Australia.
Marcus ChenMelbourne Sexual Health Centre, Alfred Health, Carlton, Australia.
Tim ReadMelbourne Sexual Health Centre, Alfred Health, Carlton, Australia.
Andrew GrulichDepartment of Medicine, Kirby Institute, University of New South Wales, Darlinghurst, Australia.
Catriona BradshawMelbourne Sexual Health Centre, Alfred Health, Carlton, Australia.
John KaldorDepartment of Medicine, Kirby Institute, University of New South Wales, Darlinghurst, Australia.
Philip ClarkeSexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Alfred Health · AUMelbourne Sexual Health Centre · AUUNSW Sydney · AUChris O’Brien Lifehouse · AUUniversity of Melbourne · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionAnal cancer in men who have sex with men (MSM) living with HIV is an important issue but there are no consistent guidelines for how to screen for this cancer. In settings where screening with anal cytology is unavailable, regular anal examinations have been proposed in some guidelines but their cost-effectiveness is unknown.

methodsOur objective was to estimate the cost-effectiveness of regular anal examinations to screen for anal cancer in HIV-positive MSM living in Australia using a probabilistic Markov model. Data sources were based on the medical literature and a clinical trial of HIV-positive MSM receiving an annual anal examination in Australia. The main outcome measures for calculating effectiveness were undiscounted and discounted (at 3%) lifetime costs, life years gained, quality-adjusted life years (QALY) gained and incremental cost-effectiveness ratio (ICER).

resultsBase-case analysis estimated the average cost of screening for and management of anal cancer ranged from $195 for no screening to $1,915 for lifetime annual screening of men aged ≥ 50. Screening of men aged ≥ 50 generated ICERs of $29,760 per QALY gained (for screening every four years), $32,222 (every three years) and $45,484 (every two years). Uncertainty for ICERs was mostly influenced by the cost (financially and decrease in quality of life) from a false-positive result, progression rate of anal cancer, specificity of the anal examination, the probability of detection outside a screening program and the discount rate.

conclusionsScreening for anal cancer by incorporating regular anal examinations into routine HIV care for MSM aged ≥ 50 is most likely to be cost-effective by conventional standards. Given that anal pap smears are not widely available yet in many clinical settings, regular anal exams for MSM living with HIV to detect anal cancer earlier should be implemented.

Indexed as

Digital Rectal ExaminationHomosexuality, MaleAdultAgedAnus NeoplasmsCost-Benefit AnalysisHIV InfectionsHumansMaleMiddle AgedQuality-Adjusted Life Yearsanal cancercost-effectivenessHIVmen who have sex with menscreening

Identifiers

PMID26942721
PMCPMC4778406
OpenAlexW2289486875

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.