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Yuan S, Zhang T, Wu Y, Lu Y, Chang F, Zhu Y. Cost-Utility Analysis of Berberine Chemoprevention for Colorectal Cancer After Polypectomy. Cureus 2024; 16:e61030. [PMID: 38915970 PMCID: PMC11194466 DOI: 10.7759/cureus.61030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/26/2024] Open
Abstract
Background Chemoprevention, such as berberine, has been developed as an alternative or complementary strategy to colonoscopy surveillance and has shown promise in reducing the morbidity and mortality of colorectal cancer. This study aims to evaluate the cost-effectiveness of berberine for postpolypectomy patients from the US third-party payer. Methods A Markov microsimulation model was developed to compare the cost and efficacy of berberine to no intervention, colonoscopy, and the combination of berberine and colonoscopy in postpolypectomy patients. Results After simulating 1 million patients, the study found that colonoscopy alone had a mean cost of $16,391 and mean quality-adjusted life-years (QALYs) of 16.03 per patient, whereas adding berberine slightly reduced the mean cost to $15,609 with a mean QALY of 16.05, making it a dominant strategy. Berberine therapy alone was less effective than colonoscopy alone, with a higher mean cost of $37,480 and a mean QALY of 15.32 per patient. However, berberine therapy was found to be a dominant strategy over no intervention. Conclusions Adding berberine to colonoscopy is the most cost-saving and effective approach for postpolypectomy patients. For patients who refuse or have limited access to colonoscopy, berberine alone is likely to be a dominant strategy compared to no intervention.
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Affiliation(s)
- Shuai Yuan
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
| | - Tian Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
| | - Yingyu Wu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
| | - Yun Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
| | - Feng Chang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
| | - Yumei Zhu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
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Sekiguchi M, Igarashi A, Sakamoto T, Saito Y, Esaki M, Matsuda T. Cost-effectiveness analysis of postpolypectomy colonoscopy surveillance using Japanese data. Dig Endosc 2019; 31:40-50. [PMID: 30062760 DOI: 10.1111/den.13250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/26/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Recommendations vary on postpolypectomy surveillance, and no consensus has been reached even regarding the necessity of risk stratification based on polyp characteristics for surveillance. We examined an optimal postpolypectomy surveillance program by performing a cost-effectiveness analysis. METHODS We performed a Markov model analysis using parameters based on Japanese data and evaluated four postpolypectomy surveillance programs with respect to their effectiveness in terms of quality-adjusted life-years (QALYs), cost-effectiveness and required number of colonoscopies. Two were non-risk-stratified programs with 1-year (program 1) and 3-year (program 2) postpolypectomy surveillance colonoscopy, and the other two were risk-stratified programs. In program 3, surveillance colonoscopy was performed 3, 10 and 10 years after resection of advanced adenomas, low-risk adenomatous polyps, and no polyps, respectively. In program 4, those intervals were shortened to 1, 3 and 5 years, respectively. RESULTS Risk-stratified programs (3 and 4) yielded higher QALYs with lower costs than non-risk-stratified programs (1 and 2). Program 4 yielded higher QALYs (23.046) and lower required cost (107,717 JPY) than program 3. The required number of colonoscopies for program 4 was 1.2, 1.5 and 1.6 times that for programs 1, 2 and 3, respectively. A probabilistic sensitivity analysis showed that the probability of program 4 being chosen as the most cost-effective was highest. CONCLUSIONS After polypectomy, risk-stratified colonoscopy surveillance based on the polyp characteristics should be considered. A risk-stratified program with relatively short examination intervals could be effective and cost-effective in Japan, although further investigation and consideration of colonoscopy capacity are required.
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Affiliation(s)
- Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Minoru Esaki
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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McFerran E, O'Mahony JF, Fallis R, McVicar D, Zauber AG, Kee F. Evaluation of the Effectiveness and Cost-Effectiveness of Personalized Surveillance After Colorectal Adenomatous Polypectomy. Epidemiol Rev 2017; 39:148-160. [PMID: 28402402 PMCID: PMC5858033 DOI: 10.1093/epirev/mxx002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 12/18/2022] Open
Abstract
Lifetime risk of developing colorectal cancer is 5%, and 5-year survival at early stage is 92%. Individuals with precancerous lesions removed at primary screening are typically recommended surveillance colonoscopy. Because greater benefits are anticipated for those with higher risk of colorectal cancer, scope for risk-specific surveillance recommendations exists. This review assesses published cost-effectiveness estimates of postpolypectomy surveillance to consider the potential for personalized recommendations by risk group. Meta-analyses of incidence of advanced neoplasia postpolypectomy for low-risk cases were comparable to those without adenoma, with both rates under the lifetime risk of 5%. This group may not benefit from intensive surveillance, which risks unnecessary harm and inefficient use of often scarce colonoscopy capacity. Therefore, greater personalization through deintensified strategies for low-risk individuals could be beneficial. The potential for noninvasive testing, such as fecal immunochemical tests, combined with primary prevention or chemoprevention may reserve colonoscopy for targeted use in personalized risk-stratified surveillance. This review appraised evidence supporting a program of personalized surveillance in patients with colorectal adenoma according to risk group and compared the effectiveness of surveillance colonoscopy with alternative prevention strategies. It assessed trade-offs among costs, benefits, and adverse effects that must be considered in a decision to adopt or reject personalized surveillance.
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Affiliation(s)
- Ethna McFerran
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - James F O'Mahony
- Centre for Health Policy and Management, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Richard Fallis
- Medical Library, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Duncan McVicar
- Queen's Management School, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Ann G Zauber
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- the United Kingdom Clinical Research Collaboration
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Omidvari AH, Meester RGS, Lansdorp-Vogelaar I. Cost effectiveness of surveillance for GI cancers. Best Pract Res Clin Gastroenterol 2016; 30:879-891. [PMID: 27938783 DOI: 10.1016/j.bpg.2016.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
Gastrointestinal (GI) diseases are among the leading causes of death in the world. To reduce the burden of GI diseases, surveillance is recommended for some diseases, including for patients with inflammatory bowel diseases, Barrett's oesophagus, precancerous gastric lesions, colorectal adenoma, and pancreatic neoplasms. This review aims to provide an overview of the evidence on cost-effectiveness of surveillance of individuals with GI conditions predisposing them to cancer, specifically focussing on the aforementioned conditions. We searched the literature and reviewed 21 studies. Despite heterogeneity of studies in terms of settings, study populations, surveillance strategies and outcomes, most reviewed studies suggested at least some surveillance of patients with these GI conditions to be cost-effective. For some high-risk conditions frequent surveillance with 3-month intervals was warranted, while for other conditions, surveillance may only be cost-effective every 10 years. Further studies based on more robust effectiveness evidence are needed to inform and optimise surveillance programmes for GI cancers.
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Affiliation(s)
- Amir-Houshang Omidvari
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.
| | - Reinier G S Meester
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.
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Pence BC, Belasco EJ, Lyford CP. Combination aspirin and/or calcium chemoprevention with colonoscopy in colorectal cancer prevention: cost-effectiveness analyses. Cancer Epidemiol Biomarkers Prev 2012; 22:399-405. [PMID: 23250933 DOI: 10.1158/1055-9965.epi-12-0658] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Clinical and cohort studies have shown that low-dose aspirin and calcium are effective low-risk strategies for primary prevention of colorectal cancer (CRC). We compared the cost-effectiveness of aspirin and calcium chemoprevention used with colonoscopy for primary prevention of CRCs. METHODS Markov chain Monte Carlo simulations for a population of 100,000 persons, with a colonoscopy compliance rate of 50%, were used for the analysis. If adenomas were detected, colonoscopy was repeated every 4 years until no adenomas were evident. Data sources included adenoma transition rates, initial adenoma and CRC incidences, and treatment complication rates from existing literature. Age-adjusted U.S. standard population mortality rates were used and costs were from Medicare reimbursement data. The target population was U.S. adults, undergoing CRC screening from ages 50 to 75 years. RESULTS Outcomes included incremental cost-effectiveness ratios (ICER), life-years saved (LYS), and cancer-free years saved (CFYS). The ICER per LYS for colonoscopy alone dominated compared with no screening. Compared with colonoscopy alone, colonoscopies with aspirin (ICER = $12,950/LYS) or calcium (ICER = $13,041/LYS) were the next most cost-effective strategies. ICERs per CFYS were $3,061 and $2,317 for aspirin and calcium, respectively, when added to colonoscopy. Sensitivity analyses indicated that initial prevalence of adenomas was a main determinant of prevention cost-effectiveness. CONCLUSION Low-dose aspirin or calcium supplementation may be beneficial when added to colonoscopy, for optimum CRC prevention, at small incremental costs. IMPACT Cost-effectiveness analyses suggest that aspirin and calcium in combination with colonoscopies are cost-effective for CRC prevention in average-risk populations.
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Affiliation(s)
- Barbara C Pence
- Corresponding Author: Barbara C. Pence, Department of Pathology, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA.
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Pence BC, Belasco EJ, Lyford CP. Prevention of Colorectal Cancer by Aspirin and/or Calcium: Efficacy, Mechanisms, and Cost Effectiveness. CURRENT COLORECTAL CANCER REPORTS 2012. [DOI: 10.1007/s11888-011-0115-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Saini SD, Schoenfeld P, Vijan S. Surveillance colonoscopy is cost-effective for patients with adenomas who are at high risk of colorectal cancer. Gastroenterology 2010; 138:2292-9, 2299.e1. [PMID: 20226186 DOI: 10.1053/j.gastro.2010.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 02/23/2010] [Accepted: 03/04/2010] [Indexed: 01/13/2023]
Abstract
BACKGROUND & AIMS Guidelines recommend that patients with colon adenomas undergo periodic surveillance colonoscopy. The purpose of this study was to estimate the cost-effectiveness of these recommendations. METHODS We developed a Markov model to study various surveillance strategies from the perspective of a long-term payer. We modeled a cohort of 50-year-old patients with newly diagnosed adenomas, following them until death. Thirty percent of the population was assumed to be at high risk for colorectal cancer. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured. RESULTS Performing colonoscopies every 3 years in high-risk patients and every 10 years in low-risk patients (3/10 strategy) was more costly but also more effective than no surveillance, with an ICER of $5,743 per QALY gained. Compared with this 3/10 strategy, a 3/5 strategy was considerably more costly but only marginally more effective, with an ICER of $296,266 per QALY. A 3/3 strategy was more costly and less effective than a 3/5 strategy (dominated). Results were most sensitive to the annual probability of advanced adenoma formation and the relative risk (RR) of advanced adenoma formation in high-risk versus low-risk patients. Assuming that the probability of advanced adenoma formation was 1.3% per year (base: 0.5%), the ICER of the 3/5 strategy was <$50,000 per QALY gained if the RR of advanced adenoma formation was <2.4 (base: 3.9). CONCLUSIONS Surveillance colonoscopy is cost-effective for patients who are at high risk for developing colorectal cancer. Aggressive surveillance can be expensive or even harmful; efforts should be made to improve risk models for colonic neoplasia.
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Affiliation(s)
- Sameer D Saini
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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