{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T07:24:11Z","timestamp":1767597851662,"version":"3.40.5"},"reference-count":49,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T00:00:00Z","timestamp":1693353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["20ck0106556h0002"],"award-info":[{"award-number":["20ck0106556h0002"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Although there is increasing evidence to suggest the cost\u2010effectiveness of aspirin use to prevent colorectal cancer (CRC) in the general population, no study has assessed cost\u2010effectiveness in patients with familial adenomatous polyposis (FAP), who are at high risk of developing CRC. We examined the cost\u2010effectiveness of preventive use of low\u2010dose aspirin in FAP patients who had undergone polypectomy in comparison with current treatment practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>We developed a microsimulation model that simulates a hypothetical cohort of the Japanese population with FAP for 40\u2009years. Three scenarios were created based on three intervention strategies for comparison with no intervention, namely intensive downstaging polypectomy (IDP) of colorectal polyps at least 5.0\u2009mm in diameter, IDP combined with low\u2010dose aspirin, and total proctocolectomy with ileal pouch\u2010anal anastomosis (IPAA). Cost\u2010effective strategies were identified using a willingness\u2010to\u2010pay threshold of USD 50,000 per QALY gained.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared with no intervention, all strategies resulted in extended QALYs (21.01\u201321.43 QALYs per individual) and showed considerably reduced colorectal cancer mortality (23.35\u201353.62 CRC deaths per 1000 individuals). Based on the willingness\u2010to\u2010pay threshold, IDP with low\u2010dose aspirin was more cost\u2010effective than the other strategies, with an incremental cost\u2010effectiveness ratio of $57 compared with no preventive intervention. These findings were confirmed in both one\u2010way sensitivity analyses and probabilistic sensitivity analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study suggests that the strategy of low\u2010dose aspirin with IDP may be cost\u2010effective compared with IDP\u2010only or IPAA under the national fee schedule of Japan.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.6488","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T05:39:13Z","timestamp":1693460353000},"page":"19137-19148","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost\u2010effectiveness of preventive aspirin use and intensive downstaging polypectomy in patients with familial adenomatous polyposis: A microsimulation modeling study"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4550-9631","authenticated-orcid":false,"given":"Eiko","family":"Saito","sequence":"first","affiliation":[{"name":"Institute for Global Health Policy Research Bureau of International Health Cooperation National Center for Global Health and Medicine  Tokyo Japan"},{"name":"Institute for Cancer Control National Cancer Center  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2054-7655","authenticated-orcid":false,"given":"Michihiro","family":"Mutoh","sequence":"additional","affiliation":[{"name":"Department of Molecular\u2010Targeting Prevention, Graduate School of Medical Science Kyoto Prefectural University of Medicine  Kyoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5980-698X","authenticated-orcid":false,"given":"Hideki","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Molecular\u2010Targeting Cancer Prevention, Graduate School of Medical Science Kyoto Prefectural University of Medicine  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Kamo","sequence":"additional","affiliation":[{"name":"Center for Medical Education Sapporo Medical University  Sapporo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keisuke","family":"Fukui","sequence":"additional","affiliation":[{"name":"Graduate School of Advanced Science and Engineering Hiroshima University  Hiroshima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megumi","family":"Hori","sequence":"additional","affiliation":[{"name":"School of Nursing University of Shizuoka  Shizuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1407-2393","authenticated-orcid":false,"given":"Yuri","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, Research &amp; 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