Can cost-effectiveness analysis inform genotype-guided aspirin use for primary colorectal cancer prevention?

Eman Biltaji, Brandon Walker, Trang H. Au, Zachary Rivers, Jennifer Ose, Christopher I. Li, Diana I. Brixner, David D. Stenehjem, Cornelia M. Ulrich

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1106-1113
Number of pages8
JournalCancer Epidemiology Biomarkers and Prevention
Volume30
Issue number6
DOIs
StatePublished - Jun 2021

Bibliographical note

Funding Information:
NCI of NIH, projects title “Discovery and Verification of Novel Biomarkers of Colorectal Cancer Recurrence” (R01CA189184). C.M. Ulrich and J. Ose received funding from the Huntsman Cancer Foundation, NCI of NIH, projects title “Meta-bolomic Strategies for Discovery and Validation of Biomarkers of Colorectal Cancer Recurrence” (R01 CA207371), and “Transdisciplinary Team Science in Colorectal Cancer” (U01 CA206110). Zachary Rivers received funding from the University of Minnesota Clinical and Translational Science Institute via the NIH’s National Center for Advancing Translational Sciences, grants TL1R002493 and UTL1R002494.

Publisher Copyright:
© 2021 American Association for Cancer Research.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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