Cost-effectiveness of aspirin chemoprevention for Barrett's esophagus
Cost-effectiveness of aspirin chemoprevention for Barrett's esophagus
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DOI：
10.1093/jnci/djh039
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发表时间：
2004-02-18
期刊：
影响因子：
--
通讯作者：
Gazelle, GS
中科院分区：
文献类型：
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作者：
Hur, C;Nishioka, NS;Gazelle, GS
背景：最近的数据表明，包括阿司匹林在内的非甾体抗炎药可以预防巴雷特食管进展为腺癌。然而，使用阿司匹林与许多潜在的并发症有关，包括胃肠道出血和出血性中风。我们使用建模方法来确定和比较阿司匹林在有或没有内镜监测的情况下预防食管腺癌的有效性和成本效益。方法：构建马尔可夫蒙特卡罗决策模型来比较巴雷特食管的四种治疗策略：阿司匹林治疗、内镜活检监测、两者或两者都不使用。每天服用肠溶阿司匹林的患者食管腺癌的发病率可降低 50%，但可能会出现与治疗相关的并发症，此时应停用阿司匹林。阿司匹林对心脏的潜在益处及其在其他癌症化学预防中的作用未包括在分析中。该分析是从 55 岁直至死亡的社会角度进行的。进行敏感性分析是为了调查模型参数的变化对各种假设下的估计成本和有效性结果的影响。结果：阿司匹林治疗比不治疗更有效且成本更低，使质量调整生命年 (QALY) 延长 0.19 个。阿司匹林和内窥镜监测相结合比没有治疗多产生了 0.27 个 QALY，但成本增加了 13 400 美元，相关增量成本效益比为 49 600 美元/QALY。阿司匹林与内窥镜监测相结合的使用主导了单独内窥镜监测的情况，导致 QALY 增加 0.06，成本减少 11 400 美元。该模型的结果对年龄的增长以及阿司匹林化学预防功效的降低或延迟敏感。结论：使用已发表的参数值，无论患者是否接受内窥镜监测，使用阿司匹林治疗巴雷特食管似乎是预防食管腺癌的一种经济有效的策略。
Background: Recent data suggest that nonsteroidal anti-inflammatory drugs, including aspirin, may prevent the progression of Barrett's esophagus to adenocarcinoma. However, use of aspirin is associated with numerous potential complications, including gastrointestinal bleeding and hemorrhagic strokes. We used a modeling approach to determine and compare the effectiveness and cost-effectiveness of aspirin with and without endoscopic surveillance to prevent esophageal adenocarcinoma. Methods: A Markov Monte Carlo decision model was constructed to compare four strategies for management of Barrett's esophagus: aspirin therapy, endoscopic surveillance with biopsies, both, or neither. Patients who took a daily enteric-coated aspirin were modeled to have a 50% reduction in the incidence of esophageal adenocarcinoma but could have complications related to therapy, at which point the aspirin was discontinued. Potential cardiac benefits of aspirin and its role in the chemoprevention of other cancers were not included in the analysis. The analysis was from a societal perspective from age 55 years until death. Sensitivity analyses were performed to investigate the effects of changes in model parameters on estimated costs and effectiveness outcomes across a wide range of assumptions. Results: Aspirin therapy was more effective and less costly than no therapy, resulting in 0.19 more quality-adjusted life years (QALYs). The combination of aspirin and endoscopic surveillance produced 0.27 more QALYs than no therapy at a cost of U.S.$13 400 more, for an associated incremental cost-effectiveness ratio of U.S.$49 600/QALY. Aspirin use in combination with endoscopic surveillance dominated endoscopic surveillance alone, resulting in 0.06 more QALYs and U.S.$11 400 less cost. The model's results were sensitive to increasing age and to decreased benefit or delay in aspirin's chemopreventive efficacy. Conclusion: Using published values of parameters, regardless of whether a patient undergoes endoscopic surveillance, aspirin use in the management of Barrett's esophagus appears to be a cost-effective strategy to prevent esophageal adenocarcinoma.