Very-low-dose aspirin and surveillance colonoscopy is cost-effective in secondary prevention of colorectal cancer in individuals with advanced adenomas: network meta-analysis and cost-effectiveness analysis

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Abstract

Background

Individuals with advanced colorectal adenomas (ACAs) are at high risk for colorectal cancer (CRC), and it is unclear which chemopreventive agent (CPA) is safe and cost-effective for secondary prevention. We aimed to determine, firstly, the most suitable CPA using network meta-analysis (NMA) and secondly, cost-effectiveness of CPA with or without surveillance colonoscopy (SC).

Methods

Systematic review and NMA of randomised controlled trials were performed, and the most suitable CPA was chosen based on efficacy and the most favourable risk–benefit profile. The economic benefits of CPA alone, 3 yearly SC alone, and a combination of CPA and SC were determined using the cost-effectiveness analysis (CEA) in the Malaysian health-care perspective. Outcomes were reported as incremental cost-effectiveness ratios (ICERs) in 2018 US Dollars ($) per quality-adjusted life-year (QALY), and life-years (LYs) gained.

Results

According to NMA, the risk–benefit profile favours the use of aspirin at very-low-dose (ASAVLD, ≤ 100 mg/day) for secondary prevention in individuals with previous ACAs. Celecoxib is the most effective CPA but the cardiovascular adverse events are of concern. According to CEA, the combination strategy (ASAVLD with 3-yearly SC) was cost-saving and dominates its competitors as the best buy option. The probability of being cost-effective for ASAVLD alone, 3-yearly SC alone, and combination strategy were 22%, 26%, and 53%, respectively. Extending the SC interval to five years in combination strategy was more cost-effective when compared to 3-yearly SC alone (ICER of $484/LY gain and $1875/QALY). However, extending to ten years in combination strategy was not cost-effective.

Conclusion

ASAVLD combined with 3-yearly SC in individuals with ACAs may be a cost-effective strategy for CRC prevention. An extension of SC intervals to five years can be considered in resource-limited countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-021-01715-7.

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Most cited references 57

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Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

Ahmedin Jemal, Lindsey A Torre, Rebecca Siegel … (2018)

This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.

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The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.

Brian Hutton, Georgia Salanti, Deborah M Caldwell … (2016)

The PRISMA statement is a reporting guideline designed to improve the completeness of reporting of systematic reviews and meta-analyses. Authors have used this guideline worldwide to prepare their reviews for publication. In the past, these reports typically compared 2 treatment alternatives. With the evolution of systematic reviews that compare multiple treatments, some of them only indirectly, authors face novel challenges for conducting and reporting their reviews. This extension of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement was developed specifically to improve the reporting of systematic reviews incorporating network meta-analyses. A group of experts participated in a systematic review, Delphi survey, and face-to-face discussion and consensus meeting to establish new checklist items for this extension statement. Current PRISMA items were also clarified. A modified, 32-item PRISMA extension checklist was developed to address what the group considered to be immediately relevant to the reporting of network meta-analyses. This document presents the extension and provides examples of good reporting, as well as elaborations regarding the rationale for new checklist items and the modification of previously existing items from the PRISMA statement. It also highlights educational information related to key considerations in the practice of network meta-analysis. The target audience includes authors and readers of network meta-analyses, as well as journal editors and peer reviewers.

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Graphical Tools for Network Meta-Analysis in STATA

Anna Chaimani, Julian P. T. Higgins, Dimitris Mavridis … (2014)

Network meta-analysis synthesizes direct and indirect evidence in a network of trials that compare multiple interventions and has the potential to rank the competing treatments according to the studied outcome. Despite its usefulness network meta-analysis is often criticized for its complexity and for being accessible only to researchers with strong statistical and computational skills. The evaluation of the underlying model assumptions, the statistical technicalities and presentation of the results in a concise and understandable way are all challenging aspects in the network meta-analysis methodology. In this paper we aim to make the methodology accessible to non-statisticians by presenting and explaining a series of graphical tools via worked examples. To this end, we provide a set of STATA routines that can be easily employed to present the evidence base, evaluate the assumptions, fit the network meta-analysis model and interpret its results.

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Author and article information

Contributors

Nathorn Chaiyakunapruk: nathorn.chaiyakunapruk@utah.edu

Journal

Journal ID (nlm-ta): BMC Gastroenterol

Journal ID (iso-abbrev): BMC Gastroenterol

Title: BMC Gastroenterology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-230X

Publication date (Electronic): 20 March 2021

Publication date PMC-release: 20 March 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 130

Affiliations

[1 ]GRID grid.223827.e, ISNI 0000 0001 2193 0096, Department of Pharmacotherapy, College of Pharmacy, , The University of Utah, ; 30 2000 E, Salt Lake City, UT 84112 USA

[2 ]GRID grid.411729.8, ISNI 0000 0000 8946 5787, Department of Pharmacy Practice, School of Pharmacy, , International Medical University, ; Bukit Jalil, 57000 Kuala Lumpur, Malaysia

[3 ]GRID grid.411729.8, ISNI 0000 0000 8946 5787, Department of Internal Medicine, School of Medicine, , International Medical University, International Medical University, ; Bukit Jalil, 57000 Kuala Lumpur, Malaysia

[4 ]GRID grid.411729.8, ISNI 0000 0000 8946 5787, Department of Surgery, , International Medical University, Negeri Sembilan, ; Jalan Rasah, 70300 Seremban, Malaysia

[5 ]GRID grid.10223.32, ISNI 0000 0004 1937 0490, Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, , Mahidol University, ; Bangkok, 10700 Thailand

[6 ]GRID grid.11875.3a, ISNI 0000 0001 2294 3534, School of Medical Sciences, , Universiti Sains Malaysia, ; Kota Bharu, Malaysia

[7 ]GRID grid.412113.4, ISNI 0000 0004 1937 1557, Gut Research Group, Faculty of Medicine, , National University of Malaysia, ; Kuala Lumpur, Malaysia

[8 ]GRID grid.440425.3, School of Pharmacy, , Monash University Malaysia, ; Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia

Article

Publisher ID: 1715

DOI: 10.1186/s12876-021-01715-7

PMC ID: 7981989

PubMed ID: 33743605

SO-VID: da97a572-ce9f-4fe6-97a9-1c4a936ee33b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 14 August 2020

Date accepted : 10 March 2021

Custom metadata

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: colorectal cancer,colorectal adenomas,chemoprevention,aspirin,surveillance colonoscopy,network meta-analysis,cost-effectiveness analysis

Data availability:

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: colorectal cancer, colorectal adenomas, chemoprevention, aspirin, surveillance colonoscopy, network meta-analysis, cost-effectiveness analysis

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Very-low-dose aspirin and surveillance colonoscopy is cost-effective in secondary prevention of colorectal cancer in individuals with advanced adenomas: network meta-analysis and cost-effectiveness analysis

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Abstract

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Karger: Gastroenterology

Most cited references 57

Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.

Graphical Tools for Network Meta-Analysis in STATA

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