Chemoprevention of colorectal cancer by aspirin: A cost-effectiveness analysis

Saud Suleiman, Douglas Rex, Amnon Sonnenberg

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Background & Aims: The aim of the study is to compare the cost-effectiveness of aspirin and colonoscopy in the prevention of colorectal cancer. Methods: A Markov process is used to follow a hypothetical cohort of 100,000 subjects aged 50 years until death. Four strategies are 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. The various strategies are compared calculating incremental cost-effectiveness ratios (ICERs). Results: The expected number of colorectal cancers is 5904 per 100,000 subjects. Colonoscopy prevents 4428 colorectal cancers and saves 7951 life-years at an ICER of $10,983 per life-year saved compared with no intervention. Aspirin prevents 2952 colorectal cancers and saves 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 results in ICER changes between $4617 and $57,080, with the 2 strategies breaking even at $70. Applying aspirin chemoprevention plus colonoscopy screening concomitantly yields an ICER of $227,607 per life-year saved compared with screening colonoscopy alone. Conclusion: 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.

Original languageEnglish
Pages (from-to)78-84
Number of pages7
JournalGastroenterology
Volume122
Issue number1
StatePublished - 2002

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Chemoprevention
Aspirin
Cost-Benefit Analysis
Colorectal Neoplasms
Colonoscopy
Costs and Cost Analysis
Markov Chains
Polyps

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Suleiman, S., Rex, D., & Sonnenberg, A. (2002). Chemoprevention of colorectal cancer by aspirin: A cost-effectiveness analysis. Gastroenterology, 122(1), 78-84.

Chemoprevention of colorectal cancer by aspirin : A cost-effectiveness analysis. / Suleiman, Saud; Rex, Douglas; Sonnenberg, Amnon.

In: Gastroenterology, Vol. 122, No. 1, 2002, p. 78-84.

Research output: Contribution to journalArticle

Suleiman, S, Rex, D & Sonnenberg, A 2002, 'Chemoprevention of colorectal cancer by aspirin: A cost-effectiveness analysis', Gastroenterology, vol. 122, no. 1, pp. 78-84.
Suleiman, Saud ; Rex, Douglas ; Sonnenberg, Amnon. / Chemoprevention of colorectal cancer by aspirin : A cost-effectiveness analysis. In: Gastroenterology. 2002 ; Vol. 122, No. 1. pp. 78-84.
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