Cost-effectiveness of aspirin adjuvant therapy in early stage colorectal cancer in older patients

Swee Sung Soon, Whay Kuang Chia, Mun Ling Sarah Chan, Gwo Fuang Ho, Xiao Jian, Yan Hong Deng, Chuen Seng Tan, Atul Sharma, Eva Segelov, Shaesta Mehta, Raghib Ali, Han Chong Toh, Hwee Lin Wee

    Research output: Contribution to journalArticle

    Abstract

    Background & Aims: 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.

    Methods: 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.

    Results: 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 USD20,000 to USD100,000.

    Conclusion: 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.

    Original languageEnglish (US)
    Article numbere107866
    JournalPLoS One
    Volume9
    Issue number9
    DOIs
    StatePublished - Sep 24 2014

    Fingerprint

    aspirin
    cost effectiveness
    Cost effectiveness
    colorectal neoplasms
    Aspirin
    adjuvants
    Cost-Benefit Analysis
    Colorectal Neoplasms
    therapeutics
    Therapeutics
    relative risk
    disease course
    Costs and Cost Analysis
    Disease Progression
    Costs
    willingness to pay
    relapse
    remission
    observational studies
    Secondary Prevention

    ASJC Scopus subject areas

    • Biochemistry, Genetics and Molecular Biology(all)
    • Agricultural and Biological Sciences(all)

    Cite this

    Soon, S. S., Chia, W. K., Chan, M. L. S., Ho, G. F., Jian, X., Deng, Y. H., ... Wee, H. L. (2014). Cost-effectiveness of aspirin adjuvant therapy in early stage colorectal cancer in older patients. PLoS One, 9(9), [e107866]. https://doi.org/10.1371/journal.pone.0107866

    Cost-effectiveness of aspirin adjuvant therapy in early stage colorectal cancer in older patients. / 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.

    In: PLoS One, Vol. 9, No. 9, e107866, 24.09.2014.

    Research output: Contribution to journalArticle

    Soon, SS, Chia, WK, Chan, MLS, Ho, GF, Jian, X, Deng, YH, Tan, CS, Sharma, A, Segelov, E, Mehta, S, Ali, R, Toh, HC & Wee, HL 2014, 'Cost-effectiveness of aspirin adjuvant therapy in early stage colorectal cancer in older patients', PLoS One, vol. 9, no. 9, e107866. https://doi.org/10.1371/journal.pone.0107866
    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. / Cost-effectiveness of aspirin adjuvant therapy in early stage colorectal cancer in older patients. In: PLoS One. 2014 ; Vol. 9, No. 9.
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    abstract = "Background & Aims: 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.Methods: 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.Results: 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 USD20,000 to USD100,000.Conclusion: 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.",
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    AU - Soon, Swee Sung

    AU - Chia, Whay Kuang

    AU - Chan, Mun Ling Sarah

    AU - Ho, Gwo Fuang

    AU - Jian, Xiao

    AU - Deng, Yan Hong

    AU - Tan, Chuen Seng

    AU - Sharma, Atul

    AU - Segelov, Eva

    AU - Mehta, Shaesta

    AU - Ali, Raghib

    AU - Toh, Han Chong

    AU - Wee, Hwee Lin

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    N2 - Background & Aims: 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.Methods: 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.Results: 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 USD20,000 to USD100,000.Conclusion: 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.

    AB - Background & Aims: 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.Methods: 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.Results: 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 USD20,000 to USD100,000.Conclusion: 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.

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