Home-Based Anal Cancer Screening Increased Participation in Cost-Effectiveness Analysis
A cost-effectiveness analysis found home-based anal cancer screening increased participation versus clinic-based screening among sexual and gender minority individuals. The approach remained investigational because the FDA has not approved self-sampling for anal cancer screening.
Home-based anal cancer screening appeared to be a cost-effective option for increasing screening rates among sexual and gender minority (SGM) individuals, according to findings published in JAMA Network Open. The results came from a cost-effectiveness analysis comparing home-based self-sampling for anal cancer screening to clinic-based screening. Screening participation in the trial was higher for home-based screening, with 89.2% of participants in that group completing the screening process compared with 74.2% in the clinic-based screening group.
Researchers used data from a prospective, 2-group, randomized trial that included SGM individuals, with 227 identified as men, aged 25 years or older who had engaged in sex with men in the past 5 years. In the current analysis, the researchers assessed screening participation, direct costs, time costs, travel costs, and cost effectiveness related to the two screening options. In total, the researchers analyzed data from 240 SGM individuals, an equal number randomly assigned to home- or clinic-based screening. The median age was 46 years and 27% of participants had HIV.
From a societal perspective, the cost per participant for home-based screening was $64.18 versus $60.40 for clinic-based screening. From the perspective of health care payers, the cost for home-based screening was $61.91 versus $42.06 for clinic-based screening. Based on those screening levels, the incremental cost-effectiveness ratio (ICER), which is measured as the additional cost needed to increase screening participation by one person, was $25.19 from the societal perspective and $132.36 from the healthcare payer perspective for home-based screening.
Among 10,000 simulations, researchers found that home-based screening was cost effective 41.4% of the time from a societal perspective, with an ICER threshold of $25. Home-based screening was cost effective 55.5% of the time at a threshold of $50 and 84.9% of the time at a threshold of $100. In simulations from the healthcare payer perspective, home-based screening was cost effective 14.0% of the time at a $100 threshold, increasing to 63.9% at a threshold of $150.
The researchers wrote that engagement in anal cancer screening faces several barriers, including limited health care access, low awareness, and a lack of physician recommendation. They also noted practical challenges for implementing home screening through mailed testing kits, including uncertainty around insurance coverage, the need for reliable lab infrastructure, and the need for clear follow-up procedures when individuals receive abnormal results. As of now, the US Food and Drug Administration has not approved self-sampling for anal cancer screening, highlighting that these approaches remain investigational and require careful implementation in research or pilot programs.