Key result
Aspirin chemoprophylaxis as an adjunct to colonoscopy screening cost $149,161 per life-year gained, and it increased costs while decreasing life-years when added to sigmoidoscopy and FOBT.
Why the study?
Is aspirin therapy cost-effective as an adjunct to colorectal cancer screening in the general U.S. population aged 50 to 80?
Is aspirin therapy cost-effective as an adjunct to colorectal cancer screening in the general U.S. population aged 50 to 80?
Aspirin chemoprophylaxis is generally not cost-effective as an adjunct to colorectal cancer screening for patients who adhere to screening.
Aspirin adjunct not cost-effective with screening; leaves open whether contemporary data alter conclusions for average-risk adults.
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.
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Ladabaum et al. (2001) studied Sporadic Colorectal Cancer. Aspirin vs. Screening alone was evaluated on Discounted cost per life-year gained. Aspirin chemoprophylaxis as an adjunct to colonoscopy screening cost $149,161 per life-year gained, and it increased costs while decreasing life-years when added to sigmoidoscopy and FOBT.
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