Abstract A63: Combination aspirin and/or calcium chemoprevention with colonoscopy in colorectal cancer prevention: Cost-effectiveness analyses

Background: Evidence from large-scale studies has shown that low dose aspirin and calcium are effective low risk strategies for primary prevention of colorectal cancer (CRC). We analyzed the cost-effectiveness of combination aspirin and calcium chemoprevention used with colonoscopy for primary prevention of CRC, using population-based compliance rates.

Methods: Cost-effectiveness of prevention strategies was compared using Markov chain Monte Carlo simulations of a hypothetical population with 100,000 persons starting at 50 years of age with a colonoscopy compliance rate of 50%. Once adenomas were detected, colonoscopy was repeated every 4 years until no adenomas recurred. Our data sources included state transition rates, CRC incidence, and treatment complication rates determined from existing literature. Age-adjusted US standard population mortality rates were used and costs were estimated from Medicare reimbursement data. The target population was US adults, ages 50 to 75, for whom primary CRC prevention methods are recommended within the general population.

Results: Outcome measures included incremental cost-effectiveness ratios, life-years saved, and cancer-free years saved. Compared to no screening, colonoscopy with aspirin and colonoscopy with both aspirin and calcium were the most cost-effective strategies based on cancer-free years saved. In terms of overall life-years saved, colonoscopy with and without aspirin were the most cost-effective options.

Conclusion: Given its strong positive effect, an aspirin-calcium regimen should be recommended for use in primary colorectal cancer prevention, especially when colonoscopy is also utilized.

Impact: Cost-effectiveness analysis is a valid tool for comparing multiple chemoprevention/screening strategies in a population.

Citation Format: Barbara C. Pence, Eric J. Belasco, Conrad P. Lyford. Combination aspirin and/or calcium chemoprevention with colonoscopy in colorectal cancer prevention: Cost-effectiveness analyses. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A63.