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Table 1 Summary of input parameters

From: 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

Parameter

Base case

SE or range

Distribution

Source/references

Annual transition probabilities

Normal to low-risk

0.1976

0.0044

Beta

Based on the National Cancer Institute pooling project [25] (S 3.1)

Low-risk state to high-risk

0.0890

0.0028

Beta

Meta-analysis of 4 data sets of population with high-risk adenomas at baseline (S 3.2)

High-risk to CRC1pre

ASR

NA

NA

Birth cohort analyses from German screening colonoscopy registry [26, 27] (S 3.3)

CRC1pre to CRC2pre

0.2800

0.0357

Beta

Estimated by calibration to the National Cancer Institute data statistics [28], 1973–1999

CRC2pre to CRC3pre

0.2800

0.0357

Beta

CRC3pre to CRC pre

0.6300

0.1405

Beta

CRC1pre to CRC1cli (by symptoms)

0.0700

0.0300

Beta

Reported in an economic evaluation by Frazier AL et al. [29]

CRC2pre to CRC2cli (by symptoms)

0.2500

0.0577

Beta

CRC3 pre to CRC3cli (by symptoms)

0.5500

0.0577

Beta

CRC4pre to CRC4cli (by symptoms)

0.8500

0.0763

Beta

CRC1cli to dead

0.0575

0.0087

Beta

Based on meta-analyses of five studies reported survival data of CRC at different stages in Malaysia (S 3.8)

CRC2cli to dead

0.0684

0.0099

Beta

CRC3cli to dead

0.0973

0.0132

Beta

CRC4cli to dead

0.1589

0.0666

Beta

Effectiveness: every 3-year colonoscopy

Low-risk state to normal

0.5800

0.0178

Beta

Based on meta-analyses of per-patient miss rate (S 3.4.1–2)

High-risk state to normal or low-risk state

0.9200

0.0204

Beta

CRC1pre to CRC1cli

0.9470

0.013

Beta

Available from a meta-analysis by Pickhardt PJ et al. [30]

CRC2pre to CRC2cli

0.9470

0.013

Beta

CRC3pre to CRC3cli

0.9800

0.9500–0.9900

Uniform

Available from an economic evaluation from the National Institute for Health Research (NIHR) (S 3.5)

CRC4pre to CRC4cli

0.9800

0.9600–1.0000

Uniform

Relative risk (RR) of benefits associated with ASAVLD

   

Normal to low-risk

0.86

0.0740

Normal

Meta-analyses of two aspirin chemoprevention RCTs [39, 40] (S 3.6)

Low-risk to high-risk

0.59

0.1352

Normal

RR of CV mortality

0.92

0.0536

Normal

Reported in a recent network meta-analysis by Veettil et al. [37]

Harms associated with interventions

Intolerability due to initial side effects of ASAVLD

0.052

0.025–0.200

Uniform

Derived from an aspirin chemoprevention trial [39]

Major bleeding (any) due to ASAVLD per year

0.0022

0.0005

Beta

Available from a meta-analysis of nine primary CV disease prevention trials [34] (S 3.7.1)

Major GI bleeding due to ASAVLD

0.0011

0.0003

Beta

Available from the systematic review undertaken for the USPSTF [35, 36] and Veettil et al. [37] (S 3.7.2)

Ulcer due to ASAVLD

0.0018

0.0002

Beta

Dyspepsia due to ASAVLD

0.1880

0.0800

Beta

Perforation due to colonoscopy (with or without polypectomy)

0.0004

0.00008

Beta

Based on a systematic review undertaken for the USPSTF by Lin JS et al. [31]

Major bleeding due to colonoscopy

0.0008

0.0002

Beta

Mortality due to perforation

0.0582

0.0100

Beta

Available from a large population-based cohort study by Gatto NM et al. [38]

Mortality due to major bleeding events

0.0600

0.0100–0.1600

Uniform

Reported in a recent network meta-analysis by Veettil et al. [37]

Utility values

Non-CRC states

0.8300

0.0500

Beta

Based on a population based cross-sectional study using EQ-5D instrument [40] (S 3.9)

CRC I

0.7400

0.0260

Beta

Ness et al. [39]

CRC II

0.7400

0.0260

Beta

CRC III

0.6700

0.0289

Beta

CRC IV

0.2500

0.0551

Beta

Colonoscopy (disutility)

0.0025

NA

NA

Reported in an economic evaluation by Saini SD et al. [57] (S 3.9)

Major GI bleeding/peptic ulcer due to ASAVLD (1 month)

0.46

NA

NA

Based on the analysis undertaken for the NICE osteoarthritis guidelines (S 3.9)

Dyspepsia (1 month)

0.73

NA

NA

Base case assumptions

Annual discount rate for costs and outcomes

0.03

NA

NA

Pharmacoeconomic guideline, Malaysia (https://www.pharmacy.gov.my/v2/en/documents/pharmacoeconomic-guideline-malaysia.html)

Compliance to surveillance colonoscopy

60%

30–100%

NA

Taylor et al. [58]

  1. ASAVLD, aspirin very-low-dose; ASR, age-specific rate; cli, clinical; CRC, colorectal cancer; NA, not applicable; pre, pre-clinical; SE, standard error