Abstract 3857: Cost-effectiveness of Aspirin for the Primary Prevention of Coronary Heart Disease
Background: Major trials have shown that aspirin was beneficial for primary prevention of coronary heart disease (CHD) but increased the risk of hemorrhagic strokes and gastrointestinal bleeding. These benefits and harms of aspirin may vary between men and women. We assessed the cost effectiveness of increased use of aspirin for primary prevention of CHD in men and women in the US population.
Methods: We used the CHD Policy Model, a validated, state-transition model of CHD events in the US population, to estimate the incremental cost effectiveness of increased aspirin as primary prevention in all eligible adults (not allergic or intolerant to aspirin) aged 35 to 84 years from 2007 to 2037 over and above the maximal use of aspirin as secondary prevention for all eligible patients with CHD. Baseline aspirin use, CHD events, and case fatality rates were derived from US national surveys and the Framingham Heart Study. Benefits and risks of aspirin were based on a gender-specific meta-analysis of major trials of aspirin in primary prevention. Cost estimates, health-related quality-of-life, and population rates of strokes and gastrointestinal bleeding were based on Medicare data and observational studies. Using a societal perspective, we examined quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios.
Results: Aspirin as primary prevention for all eligible adults without CHD would result in 1.5 million fewer deaths, save 10,000,000 QALYs, and save $270 billion over 30 years, over and above the benefits of maximal secondary prevention in patients with CHD. Reductions in CHD events, ischemic strokes in women, and costs outweighed the side-effects and costs of aspirin. Benefits were derived mainly from increased QALYs and reduced costs in men aged ≥ 55 and women ≥ 65. The reduction in death rates was greatest in women ≥ 65, because of the reduction in both CHD and ischemic strokes by aspirin.
Conclusions: The increased use of aspirin for primary prevention especially in men aged 55– 84 and women aged 65– 84 without CHD would lead to important gains in health and would be potentially cost saving, above and beyond the benefits of maximal use of aspirin for secondary prevention.