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ARTICLE

Aspirin as an Adjunct to Screening for Prevention of Sporadic Colorectal Cancer: A Cost-Effectiveness Analysis

Uri Ladabaum, MD, MS; Cathy Lee Chopra, MD, MS; Grace Huang, MD, MS; James M. Scheiman, MD; Michael E. Chernew, PhD; and A. Mark Fendrick, MD

6 November 2001 | Volume 135 Issue 9 | Pages 769-781

Background: Aspirin may decrease colorectal cancer incidence, but its role as an adjunct to or substitute for screening has not been evaluated.

Objective: To examine the potential cost-effectiveness of aspirin chemoprophylaxis in relation to screening.

Design: Markov model.

Data Sources: Literature on colorectal cancer epidemiology, screening, costs, and aspirin chemoprevention (1980–1999).

Target Population: General U.S. population.

Time Horizon: 50 to 80 years of age.

Perspective: Third-party payer.

Intervention: 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).

Outcome Measures: Discounted cost per life-year gained.

Results of Base-Case Analysis: 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.

Results of Sensitivity Analysis: 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.

Conclusions: 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.

Author and Article Information

From University of California, San Francisco, San Francisco, California; and University of Michigan, Ann Arbor, Michigan.

Acknowledgment: The authors thank Dr. David Glidden of the University of California, San Francisco, General Clinical Research Center for assistance with the Monte Carlo simulation.

Grant Support: By grants from the National Institutes of Health to the University of Michigan and the University of California, San Francisco, General Clinical Research Centers (M01-RR00042 and M01-RR00079), including a Clinical Associate Physician Award to Dr. Ladabaum.

Requests for Single Reprints: Uri Ladabaum, MD, MS, Division of Gastroenterology, S-357, Box 0538, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143-0538.

Current Author Addresses: Dr. Ladabaum: Division of Gastroenterology, S-357 Box 0538, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143-0538.

Dr. Lee Chopra: Division of Geriatric Medicine, 1500 East Medical Center Drive, CCGCB 1127/0920, University of Michigan, Ann Arbor, MI 48109.

Dr. Huang: Mental Health Research Institute, 205 Zina Pitcher Place, University of Michigan, Ann Arbor, MI 48109-0720.

Dr. Scheiman: Division of Gastroenterology, 3912 Taubman Center, University of Michigan, Ann Arbor, MI 48109-0362.

Dr. Chernew: Department of Health Management and Policy, SPH-2 HMP, 109 Observatory, University of Michigan, Ann Arbor, MI 48109-2029.

Dr. Fendrick: Division of General Medicine, 1500 East Medical Center Drive, University of Michigan, Ann Arbor, MI 48109.

Author Contributions: Conception and design: U. Ladabaum, C. Lee Chopra, G. Huang, J.M. Scheiman, M.E. Chernew, A.M. Fendrick.

Analysis and interpretation of the data: U. Ladabaum, C. Lee Chopra, G. Huang, J.M. Scheiman, M.E. Chernew, A.M. Fendrick.

Drafting of the article: U. Ladabaum, J.M. Scheiman, A.M. Fendrick.

Critical revision of the article for important intellectual content: U. Ladabaum, J.M. Scheiman, A.M. Fendrick.

Final approval of the article: U. Ladabaum, J.M. Scheiman, M.E. Chernew, A.M. Fendrick.

Provision of study materials or patients: U. Ladabaum.

Statistical expertise: U. Ladabaum.

Administrative, technical, or logistic support: U. Ladabaum, J.M. Scheiman, M.E. Chernew, A.M. Fendrick.

Collection and assembly of data: U. Ladabaum, C. Lee Chopra.

Related articles in Annals:

Summaries for Patients
Is Aspirin a Cost-Effective Addition to Colorectal Cancer Screening?

Annals 2001 135: S51. [Full Text]  

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