ArticleCancer2017
Management of precancerous anal intraepithelial lesions in human immunodeficiency virus-positive men who have sex with men: Clinical effectiveness and cost-effectiveness.
Article in Cancer, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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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.
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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.
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Who cites it
21 citing papers in PubMed, 36 citations in OpenAlex.
- Evaluation of Anal Cancer Screening Among 18-to-34-Year-Old Men Who Have Sex With Men Living With HIV Over a 10-Year Period.Open forum infectious diseases · 2026Article
- No Time for That: Health Care Economics and Population Health Limitations of Anal Cancer Screening.Clinics in colon and rectal surgery · 2026Review
- Article
- Anal cancer screening results from 18-to-34-year-old men who have sex with men living with HIV.International journal of cancer · 2024Article
- Safety, feasibility, and short-term-outcome of anal endoscopic submucosal dissection for anal intraepithelial neoplasia: an option for focal lesions?Techniques in coloproctology · 2023Article
- Human Papillomavirus-Associated Anal Cancer Incidence and Burden Among US Men, According to Sexual Orientation, Human Immunodeficiency Virus Status, and Age.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Review
- Cost-effectiveness of screening and treating anal pre-cancerous lesions among gay, bisexual and other men who have sex with men living with HIV.The Lancet regional health. Western Pacific · 2023Article
- Global burden of HPV-attributable squamous cell carcinoma of the anus in 2020, according to sex and HIV status: A worldwide analysis.International journal of cancer · 2023Article
- Comparison of anal pre-cancer screening strategies among men who have sex with men.International journal of STD & AIDS · 2023Article
- Incidence Trends and Burden of Human Papillomavirus-Associated Cancers Among Women in the United States, 2001-2017.Journal of the National Cancer Institute · 2021Article
- High-resolution anoscopy, is there a benefit in proceeding directly to the operating room?Techniques in coloproctology · 2021Article
- Squamous Cell Carcinoma of the Anus Incidence, Mortality, and Survival Among the General Population and Persons Living With HIV in Puerto Rico, 2000-2016.JCO global oncology · 2021Article
- Administering the HPV Vaccine to People Living with HIV: Providers' Perspectives.The journal of primary prevention · 2020Article
- Recent Trends in Squamous Cell Carcinoma of the Anus Incidence and Mortality in the United States, 2001-2015.Journal of the National Cancer Institute · 2020Article
- Article
- Serological Assessment of 18 Pathogens and Risk of AIDS-Associated Non-Hodgkin Lymphoma.Journal of acquired immune deficiency syndromes (1999) · 2019Article
- Trends in Risks for Second Primary Cancers Associated With Index Human Papillomavirus-Associated Cancers.JAMA network open · 2018Article
- The Diagnostic and Therapeutic Challenge of Anal Intraepithelial Neoplasia.Current gastroenterology reports · 2018Review
- Recent advances in the management of anal cancer.F1000Research · 2018Review
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Authors and funding
9 authors at 9 institutions in 1 country.
Funding
Abstract
backgroundHuman immunodeficiency virus (HIV)-positive men who have sex with men (MSM) are at disproportionately high risk for anal cancer. There is no definitive approach to the management of high-grade squamous intraepithelial lesions (HSIL), which are precursors of anal cancer, and evidence suggests that posttreatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves HSIL treatment effectiveness. The objectives of this study were to evaluate the optimal HSIL management strategy with respect to clinical effectiveness and cost-effectiveness and to identify the optimal age for initiating HSIL management.
methodsA decision analytic model of the natural history of anal carcinoma and HSIL management strategies was constructed for HIV-positive MSM who were 27 years old or older. The model was informed by the Surveillance, Epidemiology, and End Results-Medicare database and published studies. Outcomes included the lifetime cost, life expectancy, quality-adjusted life expectancy, cumulative risk of cancer and cancer-related deaths, and cost-effectiveness from a societal perspective.
resultsActive monitoring was the most effective approach in patients 29 years or younger; thereafter, HSIL treatment plus adjuvant qHPV vaccination became most effective. When cost-effectiveness was considered (ie, an incremental cost-effectiveness ratio [ICER] < $100,000/quality-adjusted life-year), do nothing was cost-effective until the age of 38 years, and HSIL treatment plus adjuvant qHPV vaccination was cost-effective beyond the age of 38 years (95% confidence interval, 34-43 years). The ICER decreased as the age at HSIL management increased. Outcomes were sensitive to the rate of HSIL regression or progression and the cost of high-resolution anoscopy and biopsy.
conclusionsThe management of HSIL in HIV-positive MSM who are 38 years old or older with treatment plus adjuvant qHPV vaccination is likely to be cost-effective. The conservative approach of no treatment is likely to be cost-effective in younger patients. Cancer 2017;123:4709-4719. © 2017 American Cancer Society.
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