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Can Cost-effectiveness Analysis Inform Genotype-Guided Aspirin Use for Primary Colorectal Cancer Prevention?
- Source :
-
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology [Cancer Epidemiol Biomarkers Prev] 2021 Jun; Vol. 30 (6), pp. 1106-1113. Date of Electronic Publication: 2021 Apr 13. - Publication Year :
- 2021
-
Abstract
- Background: 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 chemoprevention in average-risk individuals.<br />Methods: A decision analytical model compared genotype-guided aspirin use versus no genetic testing, no aspirin. The model simulated 100,000 adults ≥50 years of age with average colorectal cancer 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 colorectal cancer risk with aspirin use. The primary outcomes were quality-adjusted life-years (QALY), costs, and incremental cost-effectiveness ratio (ICER).<br />Results: The mean cost of using genotype-guided aspirin was $187,109 with 19.922 mean QALYs compared with $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 the $100,000 willingness-to-pay threshold. Genotype-guided aspirin was associated with 1,461 fewer polyps developed, 510 fewer colorectal cancer cases, and 181 fewer colorectal cancer-related deaths. This strategy prevented 1,078 myocardial infarctions with 1,430 gastrointestinal bleeding events, and 323 intracranial hemorrhage cases compared with no genetic testing, no aspirin.<br />Conclusions: Genotype-guided aspirin use for colorectal cancer chemoprevention may offer a cost-effective approach for the future management of average-risk individuals.<br />Impact: A genotype-guided aspirin strategy may prevent colorectal cancer, colorectal cancer-related deaths, and myocardial infarctions, while minimizing bleeding adverse events. This model establishes a framework for genetically-guided aspirin use for targeted chemoprevention of colorectal cancer with application toward commercial testing in this population.<br /> (©2021 American Association for Cancer Research.)
- Subjects :
- Aspirin economics
Aspirin pharmacokinetics
Colorectal Neoplasms economics
Colorectal Neoplasms epidemiology
Colorectal Neoplasms genetics
Computer Simulation
Dose-Response Relationship, Drug
Feasibility Studies
Genetic Testing economics
Genetic Testing statistics & numerical data
Genotype
Humans
Middle Aged
Models, Economic
Myocardial Infarction economics
Myocardial Infarction epidemiology
Myocardial Infarction genetics
Pharmacogenomic Variants
Precision Medicine economics
Precision Medicine methods
Primary Prevention economics
Quality-Adjusted Life Years
Aspirin administration & dosage
Colorectal Neoplasms prevention & control
Cost-Benefit Analysis statistics & numerical data
Myocardial Infarction prevention & control
Primary Prevention methods
Subjects
Details
- Language :
- English
- ISSN :
- 1538-7755
- Volume :
- 30
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 33849967
- Full Text :
- https://doi.org/10.1158/1055-9965.EPI-19-1580