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Ann Intern Med. 2001 Nov 6;135(9):769-81.

Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer. A cost-effectiveness analysis.

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  • 1Division of Gastroenterology, S-357 Box 0538, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143-0538, USA.

Abstract

BACKGROUND:

Aspirin may decrease colorectal cancer incidence, but its role as an adjunct to or substitute for screening has not been evaluated.

OBJECTIVE:

To examine the potential cost-effectiveness of aspirin chemoprophylaxis in relation to screening.

DESIGN:

Markov model.

DATA SOURCES:

Literature on colorectal cancer epidemiology, screening, costs, and aspirin chemoprevention (1980-1999).

TARGET POPULATION:

General U.S. population.

TIME HORIZON:

50 to 80 years of age.

PERSPECTIVE:

Third-party payer.

INTERVENTION:

Aspirin therapy in patients screened with sigmoidoscopy every 5 years and fecal occult blood testing every year (FS/FOBT) or colonoscopy every 10 years (COLO).

OUTCOME MEASURES:

Discounted cost per life-year gained.

RESULTS OF BASE-CASE ANALYSIS:

When a 30% reduction in colorectal cancer risk was assumed, aspirin increased costs and decreased life-years because of related complications as an adjunct to FS/FOBT and cost $149 161 per life-year gained as an adjunct to COLO. In patients already taking aspirin, screening with FS/FOBT or COLO cost less than $31 000 per life-year gained.

RESULTS OF SENSITIVITY ANALYSIS:

Cost-effectiveness estimates depended highly on the magnitude of colorectal cancer risk reduction with aspirin, aspirin-related complication rates, and the screening adherence rate in the population. However, when the model's inputs were varied over wide ranges, aspirin chemoprophylaxis remained generally non-cost-effective for patients who adhere to screening.

CONCLUSIONS:

In patients undergoing colorectal cancer screening, aspirin use should not be based on potential chemoprevention. Aspirin chemoprophylaxis alone cannot be considered a substitute for colorectal cancer screening. Public policy should focus on improving screening adherence, even in patients who are already taking aspirin.

PMID:
11694102
[PubMed - indexed for MEDLINE]
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