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.
@article{697652a2c1ed4aecb28c074f240bedf8,
title = "Cost-effectiveness of aspirin adjuvant therapy in early stage colorectal cancer in older patients",
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.",
author = "Soon, {Swee Sung} and Chia, {Whay Kuang} and Chan, {Mun Ling Sarah} and Ho, {Gwo Fuang} and Xiao Jian and Deng, {Yan Hong} and Tan, {Chuen Seng} and Atul Sharma and Eva Segelov and Shaesta Mehta and Raghib Ali and Toh, {Han Chong} and Wee, {Hwee Lin}",
year = "2014",
month = "9",
day = "24",
doi = "10.1371/journal.pone.0107866",
language = "English (US)",
volume = "9",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "9",

}

TY - JOUR

T1 - Cost-effectiveness of aspirin adjuvant therapy in early stage colorectal cancer in older patients

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

PY - 2014/9/24

Y1 - 2014/9/24

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.

UR - http://www.scopus.com/inward/record.url?scp=84907459408&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907459408&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0107866

DO - 10.1371/journal.pone.0107866

M3 - Article

VL - 9

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 9

M1 - e107866

ER -