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Evidence Table 4.1. Cost-effectiveness analysis—Suleiman 200273

Study typeDecision analysis using a Markov model

Do nothing


Colonoscopy q10 y; q3 y if polyp(s) found


ASA 325mg po daily


Colonoscopy q10 y + ASA 325mg po daily

Study population 100 000 average-risk subjects age 50 followed until death
Economical context Third-party payer perspective in U.S. dollars discounted at 3% per year
Probabilities (range used in sensitivity analysis) Incidence polyps: 0.01/yr
Age-specific incidence CRC: from SEER data 1973-94
Efficacy of colonoscopy at preventing CRC: 75% (50–75%)
Efficacy of ASA at preventing CRC: 50% (25–75%)
Efficacy of ASA+colonoscopy at preventing CRC: 87.5% (50–100%)
Mortality from CRC: 40%
Effect of ASA on cardiovascular outcomes: not modeled
Compliance to interventions: 100%
Costs (range used in sensitivity analysis) ASA: $172/PY ($20–200) (includes costs of complications)
Colonoscopy: $696
Colonoscopy with polypectomy: $1004
Care for CRC: $45 228 (up to $60 000)
Outcomes Screening vs do nothing:
  • saves 7,951 LYs for $223,780,829
  • ICER $10,983/LY saved
ASA vs do nothing:
  • Saves 5,301 LYs for $386,920,810
  • ICER $47,249/LY saved
ASA + screening vs do nothing
  • ICER $41,929/LY saved
ASA+screening vs screening alone
  • ICER $227,607/LY saved
Sensitivity Analyses Cost of ASA (including drug cost and cost of complications) needs to fall below $70/patient/y for ASA to be more cost-effective than screening

From: Appendix 8. Figures and Tables

Cover of Use of Aspirin and NSAIDs to Prevent Colorectal Cancer
Use of Aspirin and NSAIDs to Prevent Colorectal Cancer [Internet].
Evidence Syntheses, No. 45.
Rostom A, Dube C, Lewin G.

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