Details

Autor(en) / Beteiligte

• Ladabaum, U
• Chopra, C L
• Huang, G
• Scheiman, J M
• Chernew, M E
• Fendrick, A M

Titel

Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer. A cost-effectiveness analysis

Ist Teil von

• Annals of internal medicine, 2001-11, Vol.135 (9), p.769

Ort / Verlag

United States

Erscheinungsjahr

2001

Quelle

MEDLINE

Beschreibungen/Notizen

• Aspirin may decrease colorectal cancer incidence, but its role as an adjunct to or substitute for screening has not been evaluated. To examine the potential cost-effectiveness of aspirin chemoprophylaxis in relation to screening. Markov model. Literature on colorectal cancer epidemiology, screening, costs, and aspirin chemoprevention (1980-1999). General U.S. population. 50 to 80 years of age. Third-party payer. 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). Discounted cost per life-year gained. 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. 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. 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.