Ospedale Nuovo Regina Margherita, Gastroenterologia ed Endoscopia Digestiva, Via Morosini 30, 00153, Roma, Italia.
Gut. 2012 Aug;61(8):1172-9. doi: 10.1136/gutjnl-2011-300206. Epub 2011 Oct 13.
Low-dose aspirin reduces colorectal cancer (CRC) incidence and mortality. Recently, the aspirin effect has been shown to occur primarily in the proximal colon. Colonoscopy has been either less effective or ineffective in the proximal compared to the distal colon. The authors assessed the cost-effectiveness of adding low-dose aspirin to a simulated screening with colonoscopy or sigmoidoscopy.
A Markov model comparing the strategies of 10-year colonoscopy or sigmoidoscopy screening and the combination of either of the two with low-dose aspirin in 100,000 subjects aged 50 years until death was constructed. Proximal and distal CRC prevention rates with endoscopy or aspirin were extracted from the literature. Screening and aspirin prevention were simulated to stop at 80 years. The cost of aspirin and aspirin-related complications, as well as aspirin-related mortality, was included. Incremental cost-effectiveness ratios between the different strategies were calculated. Sensitivity and probabilistic analyses were also performed.
The addition of low-dose aspirin to colonoscopy and sigmoidoscopy screening increased the CRC death prevention rate from 68% and 39% to 81% and 69%, respectively. Lifetime aspirin-related mortality appeared to be 0.1%. Because of the substantial reduction in CRC care, the addition of aspirin to colonoscopy and sigmoidoscopy screening was cost-effective (incremental cost-effectiveness ratio: US$5413 per life-year saved) and cost saving (US$278 per person), respectively. When the proximal CRC prevention rate with colonoscopy was increased 56% to 73% from the baseline, the addition of aspirin was no longer cost-effective. The addition of aspirin to colonoscopy and sigmoidoscopy was a cost-effective strategy in 52% and 94% of the scenarios at probabilistic analysis.
When assuming a suboptimal efficacy of endoscopy in preventing CRC, the addition of low-dose aspirin may be an effective and cost-effective strategy, mainly because of its high efficacy in preventing proximal CRC.
小剂量阿司匹林可降低结直肠癌（CRC）的发病率和死亡率。最近，阿司匹林的作用主要发生在近端结肠。与远端结肠相比，结肠镜检查在近端结肠的效果要么较差，要么无效。作者评估了在结肠镜检查或乙状结肠镜检查模拟筛查中添加小剂量阿司匹林的成本效益。
建立了一个马尔可夫模型，比较了 10 年结肠镜或乙状结肠镜筛查策略，以及将这两种策略中的任何一种与 10 万名 50 岁患者的小剂量阿司匹林联合使用的策略，直至死亡。从文献中提取了内镜或阿司匹林预防近端和远端 CRC 的预防率。模拟筛查和阿司匹林预防在 80 岁时停止。包括阿司匹林和阿司匹林相关并发症的成本，以及阿司匹林相关死亡率。计算了不同策略之间的增量成本效益比。还进行了敏感性和概率分析。
将小剂量阿司匹林添加到结肠镜和乙状结肠镜筛查中，将 CRC 死亡预防率从 68%和 39%提高到 81%和 69%。终生阿司匹林相关死亡率似乎为 0.1%。由于 CRC 治疗的大量减少，阿司匹林添加到结肠镜和乙状结肠镜筛查中具有成本效益（增量成本效益比：每挽救 1 个生命的成本为 5413 美元），且具有成本节约（每人 278 美元）。当结肠镜检查预防近端 CRC 的比率从基线增加 56%至 73%时，添加阿司匹林不再具有成本效益。在概率分析中，52%和 94%的情况下，阿司匹林添加到结肠镜和乙状结肠镜检查是一种具有成本效益的策略。
当假设内镜预防 CRC 的疗效不理想时，添加小剂量阿司匹林可能是一种有效且具有成本效益的策略，主要是因为其在预防近端 CRC 方面的高疗效。
