title: Cost-effectiveness of aspirin, celecoxib, and calcium chemoprevention for colorectal cancer.
abstract: BACKGROUND
  Studies have indicated that aspirin chemoprevention may be effective in preventing colorectal cancer within the general population, and aspirin, celecoxib, and calcium may be effective in preventing adenomas within those people who have previously undergone polypectomy.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of aspirin, celecoxib, and calcium chemoprevention in the context of the fecal occult blood test screening program.
  
  
  METHODS
  An existing state transition model developed to assess colorectal cancer screening options was modified to incorporate the costs and outcomes associated with chemoprevention. Relative risks of disease progression were incorporated based on the effectiveness of the chemopreventive agents. Additional benefits and harms associated with chemoprevention were included. Sensitivity analyses were undertaken.
  
  
  RESULTS
  Aspirin chemoprevention plus screening within the general population aged 50 to 60 years is estimated to cost £23,000 per quality-adjusted life year (QALY) gained compared with screening alone (based on 2008 prices). For individuals who have undergone polypectomy, calcium is estimated to cost between £8000 and £30,000 per QALY gained depending on the starting and stopping age of the chemoprevention policy. Based on current evidence, calcium has a higher probability than aspirin of providing value for money within this population, although the long-term benefits and harms are subject to considerable uncertainty. Celecoxib chemoprevention is unlikely to be considered to be cost-effective.
  
  
  CONCLUSIONS
  Calcium chemoprevention is likely to be a cost-effective option for individuals who have undergone polypectomy. Further research is required to assess the long-term benefits and harms of calcium compared with aspirin chemoprevention. Chemoprevention appears less economically attractive within the general population.
authors.affiliation: Department of Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, United Kingdom. h.squires@sheffield.ac.uk
authors.forename: Hazel
authors.initials: H
authors.lastname: Squires
authors.forename: Paul
authors.initials: P
authors.lastname: Tappenden
authors.forename: Katy
authors.initials: K
authors.lastname: Cooper
authors.forename: Christopher
authors.initials: C
authors.lastname: Carroll
authors.forename: Richard
authors.initials: R
authors.lastname: Logan
authors.forename: Daniel
authors.initials: D
authors.lastname: Hind
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016588:Anticarcinogenic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002118:Calcium / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D000068579:Celecoxib; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D009780:Occult Blood; D011720:Pyrazoles / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D013449:Sulfonamides / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006113:United Kingdom
chemical_list: D016588:Anticarcinogenic Agents; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib; D002118:Calcium