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

Cancer Epidemiol Biomarkers Prev. 2021 Jun;30(6):1106-1113. doi: 10.1158/1055-9965.EPI-19-1580. Epub 2021 Apr 13.

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.

Publication types

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

MeSH terms

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

Substances

  • Aspirin