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Using Aspirin to Prevent Colon Cancer: A Cost Analysis

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with 30 percent to 50 percent reductions in risk for colorectal cancer mortality. Researchers in this study used a decision analytic model to explore the incremental clinical and economic effects of adding aspirin therapy to screening for sporadic colorectal cancer in adults aged 50 to 80. The screening strategies examined were flexible sigmoidoscopy every 5 years plus annual fecal occult blood testing (FOBT) or colonoscopy every 10 years.

The rate and cost of complications related to aspirin therapy determined its cost-effectiveness. Assuming a 30 percent reduction in colorectal cancer risk with aspirin use, adding aspirin therapy to screening with flexible sigmoidoscopy and FOBT increased cost and decreased life-years because of aspirin-related complications. Adding aspirin therapy to colonoscopy was not cost-effective ($149,161 per life-year gained). However, in patients who were taking aspirin already, screening with either strategy was cost-effective ( < $31,000 per life-year gained). Aspirin chemoprevention was not cost-effective in patients who adhered to screening for a range of estimated aspirin-related colorectal cancer risk reduction rates (from 5 percent to 55 percent), aspirin-related complication rates, and screening adherence rates. The authors concluded that decisions about aspirin use should be based on cardiovascular risk, not colorectal cancer prevention.

Comment: These results suggest that routine aspirin use is not warranted to prevent colorectal cancer because screening is sufficiently cost-effective, aspirin is relatively ineffective, and risks for and costs of aspirin-related complications may outweigh the benefits. COX-2 inhibitors are unlikely to fare as well as aspirin in similar models, given their higher cost. These analyses, however, do not exclude the possibility that it still may be appropriate to prescribe aspirin or other NSAIDs for colorectal cancer chemoprevention in patients at very high risk for colorectal cancer, particularly if they do not adhere to screening protocols.

— DK Rex

Published in Journal Watch Gastroenterology November 27, 2001

Citation(s):

Ladabaum U et al. Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer: A cost-effectiveness analysis. Ann Intern Med 2001 Nov 6 135 769-781.

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