Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer - A cost-effectiveness analysis
Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer - A cost-effectiveness analysis
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DOI：
10.7326/0003-4819-135-9-200111060-00007
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发表时间：
2001-11-06
影响因子：
39.2
通讯作者：
Fendrick, AM
中科院分区：
文献类型：
--
作者：
Ladabaum, U;Chopra, CL;Fendrick, AM
背景：阿司匹林可能会降低结直肠癌的发病率，但其作为筛查的辅助手段或替代方法的作用尚未得到评估。
目的：研究阿司匹林化学预防相对于筛查的潜在成本效益。
设计：马尔可夫模型。
数据来源：1980 - 1999年间有关结直肠癌流行病学、筛查、成本以及阿司匹林化学预防的文献。
目标人群：美国普通人群。
时间跨度：50至80岁。
视角：第三方支付者。
干预措施：对每5年接受乙状结肠镜检查且每年接受粪便潜血试验（FS/FOBT）或每10年接受结肠镜检查（COLO）的患者进行阿司匹林治疗。
结果衡量指标：每获得一个生命年的贴现成本。
基础案例分析结果：当假定结直肠癌风险降低30%时，作为FS/FOBT的辅助手段，阿司匹林因相关并发症增加了成本并减少了生命年；作为COLO的辅助手段，每获得一个生命年的成本为149161美元。在已经服用阿司匹林的患者中，采用FS/FOBT或COLO进行筛查，每获得一个生命年的成本低于31000美元。
敏感性分析结果：成本效益评估在很大程度上取决于阿司匹林降低结直肠癌风险的程度、阿司匹林相关并发症发生率以及人群中的筛查依从率。然而，当模型的输入在较大范围内变化时，对于坚持筛查的患者，阿司匹林化学预防通常仍然不具有成本效益。
结论：在接受结直肠癌筛查的患者中，阿司匹林的使用不应基于潜在的化学预防作用。单独的阿司匹林化学预防不能被视为结直肠癌筛查的替代方法。公共政策应侧重于提高筛查依从性，即使是在已经服用阿司匹林的患者中也是如此。
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.