Can Cost-effectiveness Analysis Inform Genotype-Guided Aspirin Use for Primary Colorectal Cancer Prevention?

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.

• Authors: Eman Biltaji, Brandon Walker, Trang H Au, Zachary Rivers, Jennifer Ose, Christopher I Li, Diana I Brixner, David D Stenehjem, Cornelia M Ulrich
• Journal: 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) Vol. 30 Issue 6 Pg. 1106-1113 (06 2021) ISSN: 1538-7755 [Electronic] United States
• PMID: 33849967 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: ©2021 American Association for Cancer Research.

Chemical References

• Aspirin

Topics

• Aspirin (administration & dosage, economics, pharmacokinetics)
• Colorectal Neoplasms (economics, epidemiology, genetics, prevention & control)
• Computer Simulation
• Cost-Benefit Analysis (statistics & numerical data)
• Dose-Response Relationship, Drug
• Feasibility Studies
• Genetic Testing (economics, statistics & numerical data)
• Genotype
• Humans
• Middle Aged
• Models, Economic
• Myocardial Infarction (economics, epidemiology, genetics, prevention & control)
• Pharmacogenomic Variants
• Precision Medicine (economics, methods)
• Primary Prevention (economics, methods)
• Quality-Adjusted Life Years