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Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk.

AbstractBACKGROUND: Aspirin is effective for the primary prevention of cardiovascular events, but it remains unclear for which subgroups of individuals aspirin is beneficial. We assessed the cost-effectiveness of aspirin separately for men and women of different ages with various levels of cardiovascular disease risk. METHODS AND RESULTS: A Markov model was developed to predict the number of cardiovascular events prevented, quality-adjusted life-years, and costs over a 10-year period. Event rates were taken from Dutch population data, and the relative effectiveness of aspirin was taken from a gender-specific meta-analysis. Sensitivity analyses and Monte Carlo simulations were conducted to evaluate the robustness of the results. In 55-year-old persons, aspirin prevented myocardial infarctions in men (127 events per 100,000 person-years) and ischemic strokes in women (17 events per 100,000 person-years). Aspirin implies a net investment and a quality-adjusted life-year gain in men 55 years of age; the incremental cost-effectiveness ratio was 111,949 euros per quality-adjusted life-year (1 euro=$1.27 as of June 2007). Aspirin was cost-effective for 55- and 65-year-old men with moderate cardiovascular risk and men 75 years of age (10-year cardiovascular disease risk >10%). Conversely, aspirin was beneficial for women 65 years of age with high cardiovascular risk and women 75 years of age with moderate cardiovascular risk (10-year cardiovascular disease risk >15%). Results were sensitive to drug treatment costs, effectiveness of aspirin treatment, and utility of taking aspirin. CONCLUSIONS: Aspirin treatment for primary prevention is cost-effective for men with a 10-year cardiovascular disease risk of >10% and for women with a risk of >15%. This occurs much later in life for women than men. Therefore, opportunities for the primary prevention of aspirin seem limited in women, and a differentiated preventive strategy seems warranted.
AuthorsJacoba P Greving, Erik Buskens, Hendrik Koffijberg, Ale Algra (Affiliation: Julius Center for Health Sciences and Primary Care, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands. J.P.Greving at umcutrecht.nl)
JournalCirculation (Circulation) Vol. 117 Issue 22 Pg. 2875-83 (Jun 3 2008) ISSN: 1524-4539 United States
PMID18506010 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Aspirin
Topics
  • Age Factors
  • Aged
  • Aspirin (economics, therapeutic use)
  • Cardiovascular Diseases (epidemiology, prevention & control)
  • Cost-Benefit Analysis
  • Drug Evaluation
  • Female
  • Humans
  • Male
  • Markov Chains
  • Middle Aged
  • Monte Carlo Method
  • Primary Prevention (methods)
  • Risk Assessment
  • Sex Factors