Arguedas M R, Heudebert G R, Wilcox C M
Department of Medicine, Division of Gastroenterology & Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA.
Aliment Pharmacol Ther. 2001 May;15(5):631-8. doi: 10.1046/j.1365-2036.2001.00969.x.
Clinical trials are currently underway evaluating the efficacy of COX-2 inhibitors in decreasing the incidence of adenomas and colorectal carcinoma in 'average' risk individuals.
To use decision analysis to compare the cost-effectiveness of celecoxib to surveillance colonoscopy in 'average' risk patients who had undergone prior adenoma resection.
A model of the natural history of adenomas after endoscopic polypectomy was constructed using probabilities from the literature. Cost estimates were obtained from available Medicare reimbursement rates and supplemented by the literature. Three strategies were evaluated: (i) no surveillance; (ii) colonoscopic surveillance; and (iii) celecoxib chemoprevention. We compared total costs and performed cost-effectiveness analysis between these strategies. The outcome measures were years of life saved and 'high-grade' adenoma prevented. Sensitivity analyses were performed on selected variables.
Our base-case analysis assumed a 50% risk reduction in the incidence of adenomas among patients using celecoxib. No surveillance was associated with a cost of $1014 per patient, and colonoscopic surveillance with a cost of $1572 per patient, whereas celecoxib use was associated with a total cost of $11,503. Ten years after the index colonoscopy, 15% of patients in the no surveillance strategy developed 'high-grade' lesions compared to 13% of patients in the colonoscopic surveillance group and 6% in the celecoxib group. There was a small gain in years of life saved (0.006) favouring celecoxib over colonoscopic surveillance. The incremental cost-effectiveness ratio of celecoxib vs. colonoscopy was $141 871 per 'high-grade' adenoma prevented and $1,715,199 per year of life saved. The most important variables in determining the cost-effectiveness of celecoxib were its cost and its efficacy.
Chemoprevention with COX-2 inhibitors in 'average-risk' postpolypectomy patients is a more expensive strategy compared to colonoscopic surveillance.
目前正在进行临床试验，评估环氧化酶-2（COX-2）抑制剂在降低“一般”风险个体腺瘤和结直肠癌发病率方面的疗效。
运用决策分析比较塞来昔布与监测性结肠镜检查在既往有腺瘤切除史的“一般”风险患者中的成本效益。
利用文献中的概率构建内镜下息肉切除术后腺瘤自然史模型。成本估计来自可用的医疗保险报销率，并辅以文献资料。评估了三种策略：（i）不进行监测；（ii）结肠镜监测；（iii）塞来昔布化学预防。我们比较了总成本，并对这些策略进行了成本效益分析。结果指标为挽救的生命年数和预防的“高级别”腺瘤。对选定变量进行了敏感性分析。
我们的基础病例分析假设使用塞来昔布的患者腺瘤发病率降低50%。不进行监测的每位患者成本为1014美元，结肠镜监测的每位患者成本为1572美元，而使用塞来昔布的总成本为11503美元。在首次结肠镜检查后10年，不进行监测策略中有15%的患者出现“高级别”病变，而结肠镜监测组为13%，塞来昔布组为6%。与结肠镜监测相比，塞来昔布在挽救生命年数方面有小幅增加（0.006）。塞来昔布与结肠镜检查相比，每预防一例“高级别”腺瘤的增量成本效益比为141871美元，每挽救一年生命的增量成本效益比为1715199美元。决定塞来昔布成本效益的最重要变量是其成本和疗效。
与结肠镜监测相比，在息肉切除术后“一般风险”患者中使用COX-2抑制剂进行化学预防是一种更昂贵的策略。
