Anal Cancer Screening Cost-Effective for HIV+ Men Who Have Sex With Men ≥35 Years of Age
TUESDAY, June 17, 2025 -- For men who have sex with men (MSM) with HIV, aged 35 years or older, anal cancer screening is cost-effective, according to a study published online June 17 in the Annals of Internal Medicine.
Ashish A. Deshmukh, Ph.D., M.P.H., from the Medical University of South Carolina in Charleston, and colleagues quantified the cost-effectiveness and benefits versus harms of different anal cancer screening strategies in a microsimulation model for MSM with HIV.
The researchers found that in the base-case analysis, screening initiation at age 35 years or older using cytology dominated initiation at ages 40 and 45 years or older, with incremental cost-effectiveness ratios (ICERs) varying from $87,731 to $350,100 for a quadrennial versus annual interval. In the comparative analysis, quadrennial human papillomavirus (HPV)16, quadrennial HPV16/18, triennial HPV16/18, triennial high-risk HPV (hrHPV), biennial HPV16/18, biennial hrHPV, annual cytology with hrHPV triage, and annual hrHPV were on the frontier of cost-effectiveness, with ICERs varying from $81,341 to $2,510,847. Triage options offered the most efficient high-resolution anoscopy use in the harm-to-benefit analysis. In the sensitivity analysis, for newly eligible persons, ICERs decreased. ICERs for cytology varied from $70,750 (quadrennial) to $223,895 (annual) for 35-year-old newly eligible MSM with HIV.
"These findings imply that value-based prioritization of anal cancer screening is needed to optimize screening use," the authors write. "The findings of this study could inform screening guidelines, improve practices, reduce screening harms and enhance benefits, and optimally streamline the use of scarce screening resources."
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