Cost-Effectiveness of Aspirin Adjuvant Therapy in Early Stage Colorectal Cancer in Older Patients

• Published in: PloS one Vol. 9; no. 9; p. e107866
• Main Authors: Soon, Swee Sung, Chia, Whay-Kuang, Chan, Mun-ling Sarah, Ho, Gwo Fuang, Jian, Xiao, Deng, Yan Hong, Tan, Chuen-Seng, Sharma, Atul, Segelov, Eva, Mehta, Shaesta, Ali, Raghib, Toh, Han-Chong, Wee, Hwee-Lin
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.09.2014; Public Library of Science (PLoS)
• Subjects: Adjuvant therapy; Age; Aged; Anti-Inflammatory Agents, Non-Steroidal - economics; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antimetabolites, Antineoplastic - economics; Antimetabolites, Antineoplastic - therapeutic use; Aspirin; Aspirin - economics; Aspirin - therapeutic use; Cancer; Cancer therapies; Capecitabine; Chemotherapy; Chemotherapy, Adjuvant - methods; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Comparators; Computer and Information Sciences; Cost analysis; Cost benefit analysis; Deoxycytidine - analogs & derivatives; Deoxycytidine - economics; Deoxycytidine - therapeutic use; Disease; Disease prevention; Fluorouracil - analogs & derivatives; Fluorouracil - economics; Fluorouracil - therapeutic use; Gene expression; Health risks; Hospitals; Humans; Markov Chains; Medicine and Health Sciences; Models, Economic; Neoplasm Recurrence, Local; Neoplasm Staging; Observational studies; Oncology; Outcome Assessment (Health Care) - economics; Outcome Assessment (Health Care) - statistics & numerical data; Patients; Pharmacy; Population; Quality-Adjusted Life Years; Remission; Remission Induction; Reproducibility of Results; Risk assessment; Secondary Prevention - methods; Sensitivity; Sensitivity analysis; Social security; Statistical analysis; Stroke; Studies; Systematic review; Therapy; Trauma; Tumors
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0107866

Recent observational studies showed that post-operative aspirin use reduces cancer relapse and death in the earliest stages of colorectal cancer. We sought to evaluate the cost-effectiveness of aspirin as an adjuvant therapy in Stage I and II colorectal cancer patients aged 65 years and older. Two five-state Markov models were constructed separately for Stage I and II colorectal cancer using TreeAge Pro 2014. Two hypothetical cohorts of 10,000 individuals at a starting age of 65 years and with colorectal cancer in remission were put through the models separately. Cost-effectiveness of aspirin was evaluated against no treatment (Stage I and II) and capecitabine (Stage II) over a 20-year period from the United States societal perspective. Extensive one-way sensitivity analyses and multivariable Probabilistic Sensitivity Analyses (PSA) were performed. In the base case analyses, aspirin was cheaper and more effective compared to other comparators in both stages. Sensitivity analyses showed that no treatment and capecitabine (Stage II only) can be cost-effective alternatives if the utility of taking aspirin is below 0.909, aspirin's annual fatal adverse event probability exceeds 0.57%, aspirin's relative risk of disease progression is 0.997 or more, or when capecitabine's relative risk of disease progression is less than 0.228. Probabilistic Sensitivity Analyses (PSA) further showed that aspirin could be cost-effective 50% to 80% of the time when the willingness-to-pay threshold was varied from USD 20,000 to USD 100,000. Even with a modest treatment benefit, aspirin is likely to be cost-effective in Stage I and II colorectal cancer, thus suggesting a potential unique role in secondary prevention in this group of patients.