Prevention of colorectal cancer with low-dose aspirin in combination with endoscopy

August's issue of Gut investigates prevention of colorectal cancer with low-dose aspirin in combination with endoscopy.

Low-dose aspirin reduces colorectal cancer 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.

Dr Cesare Hassan and colleagues from Italy assessed the cost-effectiveness of adding low-dose aspirin to a simulated screening with colonoscopy or sigmoidoscopy.

A Markov model comparing the strategies of 10-year colonoscopy or sigmoidoscopy screening and the combination of either of the 2 with low-dose aspirin in 100,000 subjects aged 50 years until death was constructed.

The research team extracted from the the literature proximal and distal colorectal cancer prevention rates with endoscopy or aspirin.

Screening and aspirin prevention were simulated to stop at 80 years.

Lifetime aspirin-related mortality appeared to be 0.1%

Gut

The research team included that cost of aspirin and aspirin-related complications, as well as aspirin-related mortality.

The team calculated incremental cost-effectiveness ratios between the different strategies.

Sensitivity and probabilistic analyses were also performed.

The team found that addition of low-dose aspirin to colonoscopy and sigmoidoscopy screening increased the colorectal cancer death prevention rate from 68% and 39% to 81% and 69%, respectively.

The researchers noted that lifetime aspirin-related mortality appeared to be 0.1%.

Because of the substantial reduction in colorectal cancer care, the addition of aspirin to colonoscopy and sigmoidoscopy screening was cost-effective, and cost saving, respectively.

When the proximal colorectal cancer prevention rate with colonoscopy was increased 56% to 73% from the baseline, the addition of aspirin was no longer cost-effective.

The team found that addition of aspirin to colonoscopy and sigmoidoscopy was a cost-effective strategy in 52% and 94% of the scenarios at probabilistic analysis.

Dr Hassan's team concluded, "When assuming a suboptimal efficacy of endoscopy in preventing colorectal cancer, the addition of low-dose aspirin may be an effective and cost-effective strategy, mainly because of its high efficacy in preventing proximal colorectal cancer."