Very-low-dose aspirin and surveillance colonoscopy is cost-effective in secondary prevention of colorectal cancer in individuals with advanced adenomas: network meta-analysis and cost-effectiveness analysis

Abstract

Background Individuals with advanced colorectal adenomas (ACAs) are at high risk for colorectal cancer (CRC), and it is unclear which chemopreventive agent (CPA) is safe and cost-effective for secondary prevention. We aimed to determine, firstly, the most suitable CPA using network meta-analysis (NMA) and secondly, cost-effectiveness of CPA with or without surveillance colonoscopy (SC). Methods Systematic review and NMA of randomised controlled trials were performed, and the most suitable CPA was chosen based on efficacy and the most favourable risk–benefit profile. The economic benefits of CPA alone, 3 yearly SC alone, and a combination of CPA and SC were determined using the cost-effectiveness analysis (CEA) in the Malaysian health-care perspective. Outcomes were reported as incremental cost-effectiveness ratios (ICERs) in 2018 US Dollars ($) per quality-adjusted life-year (QALY), and life-years (LYs) gained. Results According to NMA, the risk–benefit profile favours the use of aspirin at very-low-dose (ASAVLD, ≤ 100 mg/day) for secondary prevention in individuals with previous ACAs. Celecoxib is the most effective CPA but the cardiovascular adverse events are of concern. According to CEA, the combination strategy (ASAVLD with 3-yearly SC) was cost-saving and dominates its competitors as the best buy option. The probability of being cost-effective for ASAVLD alone, 3-yearly SC alone, and combination strategy were 22%, 26%, and 53%, respectively. Extending the SC interval to five years in combination strategy was more cost-effective when compared to 3-yearly SC alone (ICER of $484/LY gain and $1875/QALY). However, extending to ten years in combination strategy was not cost-effective. Conclusion ASAVLD combined with 3-yearly SC in individuals with ACAs may be a cost-effective strategy for CRC prevention. An extension of SC intervals to five years can be considered in resource-limited countries.

Oral aspirin for preventing colorectal adenoma recurrence: A systematic review and network meta-analysis of randomized controlled trials

“…Although we were unable to fully explain this tendency, we presume that this finding is valuable for clinical practice. One recent study recommended using aspirin at a dose of less than 100 mg to avoid advanced lesions [ 34 ]. Furthermore, within a secure dose range, a lower dose generally offers more advantages over higher doses, including reduced costs (economic effectiveness), fewer side effects, and greater therapeutic efficacy [ 35 ].…”

Cost-Utility Analysis of Berberine Chemoprevention for Colorectal Cancer After Polypectomy

“…Transition probability from low- to high-risk adenoma and from high-risk adenoma to CRC in the berberine group was not available in the clinical trial. Therefore, the study assigned a realistic estimate of the placebo group to the berberine group in the base case according to previous literature [ 26 , 27 ]. The effectiveness of colonoscopy depends on the efficacy of colonoscopy plus polypectomy to prevent CRCs [ 26 ].…”

“…Therefore, the study assigned a realistic estimate of the placebo group to the berberine group in the base case according to previous literature [ 26 , 27 ]. The effectiveness of colonoscopy depends on the efficacy of colonoscopy plus polypectomy to prevent CRCs [ 26 ]. Since the berberine treatment induced a few severe complications (constipation, 1%; hepatic dysfunction, less than 0.5%), the model only simulated the complications for colonoscopy [ 28 ].…”