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Can Cost-effectiveness Analysis Inform Genotype-Guided Aspirin Use for Primary Colorectal Cancer Prevention?
- Source :
- Cancer Epidemiol Biomarkers Prev
- Publication Year :
- 2020
-
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. 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). 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. Conclusions: Genotype-guided aspirin use for colorectal cancer chemoprevention may offer a cost-effective approach for the future management of average-risk individuals. 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.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Gastrointestinal bleeding
Genotype
Pharmacogenomic Variants
Epidemiology
Colorectal cancer
Cost-Benefit Analysis
Population
Myocardial Infarction
Article
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
Computer Simulation
Genetic Testing
Precision Medicine
education
Adverse effect
Genetic testing
Aspirin
education.field_of_study
medicine.diagnostic_test
Dose-Response Relationship, Drug
business.industry
Cost-effectiveness analysis
Middle Aged
medicine.disease
Primary Prevention
030104 developmental biology
Models, Economic
Oncology
030220 oncology & carcinogenesis
Feasibility Studies
Quality-Adjusted Life Years
business
Colorectal Neoplasms
medicine.drug
Subjects
Details
- ISSN :
- 15387755
- Volume :
- 30
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Cancer epidemiology, biomarkersprevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
- Accession number :
- edsair.doi.dedup.....f94d1894e2d578888058da8494d8e02f