for new standard of care seen with 24-hour stay using epidural,
non-narcotic pain relief
Originally posted November 6, 2001
ANN ARBOR, MI - Some animal studies have
shown that aspirin and other nonsteroidal anti-inflammatory
drugs (NSAIDs) have an anti-tumor effect in the colon. Also,
some studies in people suggest that these drugs may decrease
the risk of colorectal cancer.
However, researchers at the University
of California, San Francisco and the University of Michigan
have determined in a recent study that aspirin is not a cost-effective
addition to the national strategy for reducing death from
"While aspirin may be of some benefit in colorectal cancer
prevention, it should not replace known screening methods,"
said Uri Ladabaum, MD, MS, UCSF assistant professor of gastroenterology
and lead author of the study, which appears in the November
6 issue of the Annals of Internal Medicine.
"In addition, in terms of cost and benefits, it does not
make sense for patients already getting regular screening
to take aspirin to prevent colorectal cancer. Screening is
highly cost-effective and remains so, even in patients already
taking aspirin for other reasons like arthritis or prevention
of heart disease."
Screening tests, including flexible sigmoidoscopy every five
years and yearly fecal occult blood testing (FS/FOBT) or screening
colonoscopy every ten years (COLO), remain the best strategies
for preventing death from colorectal cancer in men and women,
according to the researchers.
Though colorectal cancer screening is highly effective, less
than half of the population seek it, said Mark Fendrick, MD,
associate professor of medicine at the University of Michigan
and a co-investigator on the study. He explained that increasing
adherence to screening should be the primary goal on the national
agenda for preventing death from colorectal cancer.
"Most colorectal cancers develop from benign growths in the
colon called polyps. Screening can detect polyps, and removing
polyps can prevent a large fraction of all colorectal cancers,"
said Ladabaum. "In addition, screening can detect cancers
early, before any symptoms have developed. By the time symptoms
develop, it is often too late to treat the cancer successfully."
Researchers constructed a computer simulation of the natural
history of colorectal cancer in patients at average risk for
the disease. In the model, investigators assumed aspirin could
reduce colorectal cancer deaths by 30 percent. Aspirin actually
increased costs and resulted in loss of life-years when used
as an adjunct to FS/BOBT. Under all circumstances, the complications
associated with aspirin (bleeding, perforated ulcer, and death)
were an important determinant of cost effectiveness, according
to the researchers.
Aspirin cost $149, 161 per life-year gained as an adjunct
to COLO. "This is the amount of money that needs to be spent
by a third party payer to cover screening, aspirin, cancer
care and the complications," said Ladabaum. "In general, interventions
that society is willing to pay for are in the range of $50,000
or less per life year gained."
Screening fits within those parameters, he explained. It
cost less than $25,000 per life-year gained and was more effective
than aspirin alone. In patients already taking aspirin, screening
with FS/BOBT or COLO cost less than $31,000 per life-year
"This highlights the need to study safer chemo-prevention
alternatives," said James Scheiman, MD, associate professor
of medicine at the University of Michigan and a co-investigator
on the study. He added that cyclooxygenase-2 (COX-2) inhibitors
may prove to be safer, but more costly.
The computer model estimated clinical and economic consequences
of six strategies: 1) no aspirin or screening, 2) FS/FOBT,
3) COLO, 4) aspirin alone (ASA), 5) FS/FOBT and aspirin, 6)
COLO and aspirin.
Beginning at 50 years of age, patients progressed through
the model for 30 one-year cycles.Principal disease states
were defined as: normal, polyp, cancer (localized, regional
or disseminated), and deceased. Researchers assumed that 90
percent of cancers develop from polyps and that cancer progresses
from localized to regional to disseminated.
Procedure costs were derived from Medicare fee schedules
and included professional fees and median procedure reimbursement.
Researchers used the wholesale cost of aspirin at the University
of Michigan pharmacy. Costs for cancer care of stage-specific
colon cancer were taken from reports to the National Cancer
Institute. All costs were in 1998 dollars.
This study was funded by grants from the National Institutes
of Health to the University of Michigan and UC San Francisco.
Written by Maureen McInaney, UCSF Public Relations
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