Combination Aspirin and/or Calcium Chemoprevention with Colonoscopy in Colorectal Cancer Prevention: Cost-effectiveness Analyses

Abstract

Background: Clinical and cohort studies have shown that low-dose aspirin and calcium are effective lowrisk strategies for primary prevention of colorectal cancer (CRC). We compared the cost-effectiveness of aspirin and calcium chemoprevention used with colonoscopy for primary prevention of CRCs.Methods: Markov chain Monte Carlo simulations for a population of 100,000 persons, with a colonoscopy compliance rate of 50%, were used for the analysis. If adenomas were detected, colonoscopy was repeated every 4 years until no adenomas were evident. Data sources included adenoma transition rates, initial adenoma and CRC incidences, and treatment complication rates from existing literature. Age-adjusted U.S. standard population mortality rates were used and costs were from Medicare reimbursement data. The target population was U.S. adults, undergoing CRC screening from ages 50 to 75 years.Results: Outcomes included incremental cost-effectiveness ratios (ICER), life-years saved (LYS), and cancerfree years saved (CFYS). The ICER per LYS for colonoscopy alone dominated compared with no screening. Compared with colonoscopy alone, colonoscopies with aspirin (ICER ¼ $12,950/LYS) or calcium (ICER ¼ $13,041/LYS) were the next most cost-effective strategies. ICERs per CFYS were $3,061 and $2,317 for aspirin and calcium, respectively, when added to colonoscopy. Sensitivity analyses indicated that initial prevalence of adenomas was a main determinant of prevention cost-effectiveness.Conclusion: Low-dose aspirin or calcium supplementation may be beneficial when added to colonoscopy, for optimum CRC prevention, at small incremental costs.Impact: Cost-effectiveness analyses suggest that aspirin and calcium in combination with colonoscopies are cost-effective for CRC prevention in average-risk populations. Cancer Epidemiol Biomarkers Prev; 22(3); 399-405. Ó2012 AACR.

Critical Analysis of Markov Models Used for the Economic Evaluation of Colorectal Cancer Screening: A Systematic Review

“…A less common strategy (n ¼ 1 of 27 [4%]) included transitions between CRC stages while assuming that each CRC stage has a without-screening state or a screen-detected state with different survival rates [38]. Few studies (n ¼ 4 of 27 [15%]) modeled CRC progression between stages, but insufficient information is provided regarding sojourn time and lead time because only diagnosed CRC states are modeled [34][35][36][37].…”

Economic evaluations of screening strategies for the early detection of colorectal cancer in the average-risk population: A systematic literature review

“…In the present review we observed that although most articles (n = 19; 58%) adequately reported study perspective, approximately 30% (n = 10) of them failed to relate it to the costs being evaluated [25,27,28,30,31,37,39,42,45,46]. Conversely, 12% (n = 4) of the studies did not report it [33,35,40,47].…”

“…Most of the studies used a health care payer (n = 14; 42,4%) [21,23–31,41,42,44,52] or a third-party payer perspective (n = 14; 42,4%) [20,22,34,36–39,43,45,46,48–51]; perspective was not reported in four studies (12,1%)[33,35,40,47]; while only one study used a societal perspective (3%)[33].…”

“…The majority of studies (n = 24; 73%) adequately reported at least 50% of the items included in the CHEERS checklist [20–23,25,26,28–32,34,36–39,41–43,48,50–52]. Despite not achieving at least 50% adherence to CHEERS recommendations, all the remaining studies (n = 9; 27%), reported at least 70% of the items included in the CHEERS, albeit incompletely [27,33,35,40,44–47,49]. These data indicate that most of the aspects considered relevant according to the CHEERS recommendations are at least partly addressed in the studies.…”

Clinically Relevant Anti-Inflammatory Agents for Chemoprevention of Colorectal Cancer: New Perspectives

“…A population-based study by De Monte et al [104] showed improved survival for type II diabetes patients with stage II and III CRC with aspirin and metformin. Several researchers have been explored combination of aspirin and calcium as one of the cost effective and low-risk strategies with colonoscopy for primary prevention of CRC [105]. …”