Potential effect of cyclooxygenase-2-specific inhibitors on the prevention of colorectal cancer: a cost-effectiveness analysis.
OBJECTIVE
To estimate the potential cost-effectiveness of colorectal cancer chemoprevention with cyclooxygenase-2-specific inhibitors (COX-2 inhibitors).


METHODS
Using a decision analytic Markov model, we estimated the discounted cost per life-year saved for three strategies: a COX-2 inhibitor alone; as an adjunct to colonoscopy every 10 years in persons at average risk of colorectal cancer; and as an adjunct to colonoscopy every 5 years in persons with first-degree relatives who had colorectal cancer.


RESULTS
In the base case, the incremental cost per life-year saved with a COX-2 inhibitor alone compared with no screening was 233,300 dollars in persons at average risk of colorectal cancer and 56,700 dollars in persons with 2 first-degree relatives who had the disease. Chemoprevention was both less effective and more costly than screening. The incremental cost per life-year saved with a COX-2 inhibitor as an adjunct to screening was 823,800 dollars in persons at average risk and 404,700 dollars in persons with 2 first-degree relatives who had colorectal cancer. Combining a COX-2 inhibitor with less frequent screening was not as cost-effective as screening at currently recommended intervals. Cost-effectiveness estimates were highly sensitive to the cost of COX-2 inhibitors and their effect on the risk of cancer.


CONCLUSIONS
Chemoprevention of colorectal cancer with COX-2 inhibitors is likely to incur substantially higher costs per life-year saved than are currently recommended screening strategies. COX-2 inhibitor use as an adjunct to screening may increase life expectancy, although at prohibitive costs, and is unlikely to result in less frequent screening.
Ladabaum
Uri
U
Division of Gastroenterology, Department of Medicine, University of California, San Francisco 94143-0538, USA. ladabau@itsa.ucsf.edu
Scheiman
James M
JM
Fendrick
A Mark
AM
D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000191:economics* / Q000473:pathology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D003661:Decision Support Techniques; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors* / Q000191:economics / Q000627:therapeutic use*; D008017:Life Expectancy; D008390:Markov Chains; D008565:Membrane Proteins; D008875:Middle Aged; D011451:Prostaglandin-Endoperoxide Synthases / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment / Q000191:economics / Q000706:statistics & numerical data; D013997:Time Factors
D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases