Can Cost-effectiveness Analysis Inform Genotype-Guided Aspirin Use for Primary Colorectal Cancer Prevention?
Can Cost-effectiveness Analysis Inform Genotype-Guided Aspirin Use for Primary Colorectal Cancer Prevention?
复制标题
成本效益分析能否为基因型引导的阿司匹林用于预防原发性结直肠癌的使用吗？
DOI：
10.1158/1055-9965.epi-19-1580
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发表时间：
2021-06
期刊：
影响因子：
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通讯作者：
Ulrich CM
中科院分区：
文献类型：
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作者：
Biltaji E;Walker B;Au TH;Rivers Z;Ose J;Li CI;Brixner DI;Stenehjem DD;Ulrich CM
Inherited genetic variants can modify the cancer-chemopreventive effect of aspirin. We evaluated the clinical and economic value of genotype-guided aspirin use for colorectal cancer (CRC) chemoprevention in average-risk individuals. A decision analytical model compared genotype-guided aspirin use vs. no genetic testing, no aspirin. The model simulated 100,000 adults ≥50 years of age with average CRC and cardiovascular disease risk. Low-dose aspirin daily starting at age 50 years was recommended only for those with a genetic test result indicating a greater reduction in CRC risk with aspirin use. The primary outcomes were quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratio (ICER). The mean cost of using genotype-guided aspirin was $187,109 with 19.922 mean QALYs compared to $186,464 with 19.912 QALYs for no genetic testing, no aspirin. Genotype-guided aspirin yielded an ICER of $66,243 per QALY gained, and was cost-effective in 58% of simulations at $100,000 willingness-to-pay threshold. Genotype-guided aspirin was associated with 1,461 fewer polyps developed, 510 fewer CRC cases, and 181 fewer CRC-related deaths. This strategy prevented 1,078 myocardial infarctions with 1,430 gastrointestinal bleeding events, and 323 intracranial hemorrhage cases compared to no genetic testing, no aspirin. Genotype-guided aspirin use for CRC chemoprevention may offer a cost-effective approach for the future management of average-risk individuals. A genotype-guided aspirin strategy may prevent CRC, CRC-related deaths, and myocardial infarctions, while minimizing bleeding adverse events. This model establishes a framework for genetically-guided aspirin use for targeted chemoprevention of CRC with application towards commercial testing in this population.
