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    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Omidvari, Amir-Houshang Meester, Reinier G.S. and Lansdorp-Vogelaar, Iris 2016. Cost Effectiveness of Surveillance in GI practice. Best Practice & Research Clinical Gastroenterology,

    Pence, Barbara C. Belasco, Eric J. and Lyford, Conrad P. 2012. Prevention of Colorectal Cancer by Aspirin and/or Calcium: Efficacy, Mechanisms, and Cost Effectiveness. Current Colorectal Cancer Reports, Vol. 8, Issue. 1, p. 51.

    Saini, Sameer D. Schoenfeld, Philip and Vijan, Sandeep 2010. Surveillance Colonoscopy Is Cost-Effective for Patients With Adenomas Who Are at High Risk of Colorectal Cancer. Gastroenterology, Vol. 138, Issue. 7, p. 2292.

  • International Journal of Technology Assessment in Health Care, Volume 25, Issue 2
  • April 2009, pp. 222-231

Can calcium chemoprevention of adenoma recurrence substitute or serve as an adjunct for colonoscopic surveillance?

  • Aasma Shaukat (a1), Murtaza Parekh (a2), Joseph Lipscomb (a3) and Uri Ladabaum (a2)
  • DOI:
  • Published online: 01 April 2009

Objectives: The aim of this study was to examine the potential cost-effectiveness of calcium chemoprevention post-polypectomy as a substitute or adjunct for surveillance.

Methods: We constructed a Markov model of post-polypectomy adenoma recurrence and colorectal cancer (CRC) development, calibrated to data from prospective chemoprevention trials of fiber, calcium, antioxidants, and aspirin. We modeled four scenarios for 50-year-old patients immediately after polypectomy: (i) natural history with no further intervention; (ii) elemental calcium 1,200 mg/day from age 50–80; (iii) surveillance colonoscopy from age 50–80 every 5 years, or 3 years for large adenoma; (iv) calcium + surveillance. Patients were followed up until age 100 or death.

Results: Calcium was cost-effective compared to natural history ($49,900/life-year gained). However, surveillance was significantly more effective than calcium (18.729 versus 18.654 life-years/patient; 76 percent versus 14 percent reduction in CRC incidence) at an incremental cost of $15,900/life-year gained. Calcium + surveillance yielded a very small benefit (0.0003 incremental life-years/patient) compared with surveillance alone, at a substantial incremental cost of $3,090,000/life-year gained.

Conclusion: Post-polypectomy calcium chemoprevention is unlikely to be a reasonable substitute for surveillance. It may be cost-effective in patients unwilling or unable to undergo surveillance.

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International Journal of Technology Assessment in Health Care
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  • EISSN: 1471-6348
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