Primary prevention of colorectal cancer with low-dose aspirin in combination with endoscopy: a cost-effectiveness analysis

Abstract

When assuming a suboptimal efficacy of endoscopy in preventing CRC, the addition of low-dose aspirin may be an effective and cost-effective strategy, mainly because of its high efficacy in preventing proximal CRC.

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

“…Therefore, chemoprevention with low-dose aspirin for 10 years or less and/or calcium for 25 years are all costeffective strategies to prevent CRCs, when combined with colonoscopy. These results showing the positive effect of low-dose aspirin chemoprevention are consistent with those found in (13). In addition, we conducted sensitivity analyses on a number of key variables, and while these analyses showed changing impacts from the different variables, the basic outcome of the results do not change.…”

“…The ICERs for aspirin þ colonoscopy, calcium þ colonoscopy, and for aspirin þ calcium þ colonoscopy were $12,950, $13,041, and $26,269, respectively, per LYS. This shows the highest cost-effectiveness for colonoscopy alone, but aspirin þ colonoscopy, calcium þ colonoscopy, and aspirin þ calcium þ colonoscopy are more effective in terms of LYS but also cost-effective in that they both fall below an ICER of $50,000 per LYS that has been used by others (13,25), as a willingness-to-pay threshold to differentiate an efficient strategy from an inefficient one. ICERs for CFYS are also shown in Table 2.…”

“…We used the following compliance rate inputs: 50% for compliance with initial colonoscopy guidelines (10, 11), 58.4% for compliance with surveillance colonoscopy following polypectomy (20), and 80% compliance each for aspirin and calcium (15,16). This differs from other cost-effectiveness analyses in that 100% compliance with colonoscopy and aspirin or calcium use was assumed in all other studies (7,8,13,14). The prevalence of any adenoma at initial colonoscopy at age 50 was 36.6 years (21), with 27.0% for low-grade polyps (21), 9.6% for a high-grade polyp (21), and 1.0% for CRCs (21).…”

“…The average cost of CRC treatment is based on (8) and is $75,930 per individual case. Complication rates for colonoscopy procedures and aspirin use [perforations, upper gastrointestinal bleeds (UGB), and deaths from complications], as well as weighted costs for CRC treatments were calculated from existing literature sources (7,8,13,14) All future costs were discounted at an annual rate of 3% (24). All inputs, ranges, and their references are listed in Table 1.…”

“…Thus, although colonoscopy is the most effective screening strategy for decreasing CRC mortality, much of the population does not participate in this strategy and, alternatively, less invasive prevention strategies become more attractive. This information led us to conduct a cost-effectiveness analysis with the following objective: to evaluate the use of low-dose aspirin, calcium supplementation and colonoscopy to reduce CRC incidence and mortality, using realworld rates of colonoscopy compliance, instead of the 100% compliance rate assumed in previous cost-effectiveness analyses of colonoscopy and primary chemoprevention (7,8,13,14).…”