TITLE

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

AUTHOR(S)
Hassan, Cesare; Rex, Douglas K.; Cooper, Gregory S.; Zullo, Angelo; Launois, Robert; Benamouzig, Robert
PUB. DATE
August 2012
SOURCE
Gut;Aug2012, Vol. 61 Issue 8, p1172
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective Low-dose aspirin reduces colorectal cancer (CRC) incidence and mortality. Recently, the aspirin effect has been shown to occur primarily in the proximal colon. Colonoscopy has been either less effective or ineffective in the proximal compared to the distal colon. The authors assessed the cost-effectiveness of adding low-dose aspirin to a simulated screening with colonoscopy or sigmoidoscopy. Design A Markov model comparing the strategies of 10-year colonoscopy or sigmoidoscopy screening and the combination of either of the two with low-dose aspirin in 100 000 subjects aged 50 years until death was constructed. Proximal and distal CRC prevention rates with endoscopy or aspirin were extracted from the literature. Screening and aspirin prevention were simulated to stop at 80 years. The cost of aspirin and aspirin-related complications, as well as aspirin-related mortality, was included. Incremental cost-effectiveness ratios between the different strategies were calculated. Sensitivity and probabilistic analyses were also performed. Results The addition of low-dose aspirin to colonoscopy and sigmoidoscopy screening increased the CRC death prevention rate from 68% and 39% to 81% and 69%, respectively. Lifetime aspirin-related mortality appeared to be 0.1%. Because of the substantial reduction in CRC care, the addition of aspirin to colonoscopy and sigmoidoscopy screening was cost-effective (incremental cost-effectiveness ratio: US$5413 per life-year saved) and cost saving (US$278 per person), respectively. When the proximal CRC prevention rate with colonoscopy was increased 56% to 73% from the baseline, the addition of aspirin was no longer cost-effective. The addition of aspirin to colonoscopy and sigmoidoscopy was a cost-effective strategy in 52% and 94% of the scenarios at probabilistic analysis. Conclusions 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.
ACCESSION #
77698676

 

Related Articles

  • Is the Effectiveness of Colonoscopy “Good Enough” for Population-Based Screening? Baxter, Nancy N.; Rabeneck, Linda // JNCI: Journal of the National Cancer Institute;1/20/2010, Vol. 102 Issue 2, p70 

    The authors feel that the effectiveness of colonoscopy in preventing colorectal cancers is not sufficient to be exposed to the risks associated with the procedure. The rate of serious adverse complications, including death due to colonoscopy is considered high for use in the general population....

  • Introduction of flexible sigmoidoscopy in screening a 'no-brainer', say experts.  // Gastrointestinal Nursing;May2010, Vol. 8 Issue 4, p14 

    The article introduces the flexible sigmoidoscopy which is a bowel cancer screening used for prevention of colorectal cancer. It informs that this technique can detect pre-cancerous polyps, which can be removed before they turn into cancer. It also mentions that with this technique sedation or...

  • Digestive Disease Week: New England Journal of Medicine.  // Biomedical Market Newsletter;5/25/2012, Vol. 21, p1 

    The article offers information on a study related with efficacy of flexible sigmoidoscopy in reduction of colorectal cancer rates.

  • Cost effective CRC screening strategies investigated.  // PharmacoEconomics & Outcomes News;1/19/2013, Issue 670, p6 

    The article discusses research on the comparative effectiveness and cost-effectiveness of screening colonoscopy and sigmoidoscopy and alternative strategies, referencing an article by R. N. Sharf and colleagues published in the December 18, 2012 issue of the "American Journal of Gastroenterology."

  • Aspirin Use and Risk of Colorectal Cancer According to BRAF Mutation Status. Nishihara, Reiko; Lochhead, Paul; Kuchiba, Aya; Seungyoun Jung; Yamauchi, Mai; Xiaoyun Liao; Imamura, Yu; Zhi Rong Qian; Morikawa, Teppei; Wang, Molin; Spiegelman, Donna; Eunyoung Cho; Giovannucci, Edward; Fuchs, Charles S.; Chan, Andrew T.; Ogino, Shuji // JAMA: Journal of the American Medical Association;6/26/2013, Vol. 309 Issue 24, p2563 

    Importance Aspirin use reduces the risk of colorectal carcinoma. Experimental evidence implicates a role of RAF kinases in up-regulation of prostaglandin-endoperoxide synthase 2 (PTGS2, cyclooxygenase 2), suggesting that BRAF-mutant colonic cells might be less sensitive to the antitumor effects...

  • Study confirms benefits of colon cancer screening. Reyes, Damaso // New York Amsterdam News;3/29/2012, Vol. 103 Issue 13, p31 

    The article reports on a study which states that colonoscopy can reduce deaths due to colon cancer by 41 percent.

  • PREVENTING COLON CANCER. Hall, Lynne L. // FDA Consumer;Nov/Dec2000, Vol. 34 Issue 6, p14 

    Discusses colon cancer prevention. Significance of screening and early detection; Discussion on virtual colonoscopy; Information on colorectal cancer and its risk factors; Signs and symptoms of the disease.

  • Aspirin every other day keeps colon cancer away.  // New Zealand Doctor;8/14/2013, p38 

    The article offers information on a study which reveals the potential of aspirin to reduce the risk of having colon cancer.

  • Aspirin's next conquest: Does it prevent colon cancer? Smigel, Kara // JNCI: Journal of the National Cancer Institute;2/2/94, Vol. 86 Issue 3, p166 

    Reports on the role of aspirin in the prevention of colon cancer. Background information; Unexpected results of study by Lynn Rosenberg and colleagues at the Slone Epidemiology Unit of the Boston University of Medicine in Massachusetts; Mechanism of action; Doubts.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics