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 24 February 2018

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News

Aspirin therapy is not a cost-effective strategy for colorectal cancer prevention

Colonoscopy is a more cost-effective strategy than aspirin therapy in the prevention of colorectal cancer, claims a team from New Mexico and Indiana, USA.

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The researchers compared the cost-effectiveness of aspirin and colonoscopy in the prevention of colorectal cancer, and reported their findings in the January issue of Gastroenterology.

A Markov process was used to follow a hypothetical cohort of 100,000 subjects aged 50 years until death.

Four strategies were compared: (1) no intervention, (2) colonoscopy once per 10 years and every 3 years in subjects with polyps, (3) chemoprevention with 325 mg of daily aspirin, and (4) combination of the second and third strategies.

Incremental cost-effectiveness ratios (ICERs) were used to compare the various strategies.

The expected number of colorectal cancers was 5904 per 100,000 subjects.

Colonoscopy was estimated to prevent 4428 colorectal cancers and save 7951 life-years at an ICER of $10,983 per life-year saved, compared with no intervention.

Cost of aspirin therapy plus complication management: $172 per year, per patient.
Gastroenterology
Aspirin prevented 2952 colorectal cancers and saved 5301 life-years at an ICER of $47,249 per life-year saved, compared with no intervention.

The cost of aspirin therapy plus management of aspirin-related complications was reported to be $172 per year per patient.

Varying the annual aspirin-related costs between $50 and $200 resulted in ICER changes between $4617 and $57,080, with the 2 strategies breaking even at $70.

Applying aspirin chemoprevention plus colonoscopy screening concomitantly yielded an ICER of $227,607 per life-year saved, compared with screening colonoscopy alone.

Author Saud Suleiman, of the Department of Veterans Affairs Medical Center, Albuquerque, New Mexico, said on behalf of the group, "As compared with colonoscopy once per 10 years, the use of aspirin to prevent colorectal cancer saves fewer lives at higher costs.

"The high complication cost and the lower efficacy of aspirin render screening colonoscopy a more cost-effective strategy to prevent colorectal cancer,"

Gastroenterology 2002; 122: 78-84
21 January 2002

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