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Ann Intern Med. 2006 Mar 7;144(5):326-36.

Aspirin, statins, or both drugs for the primary prevention of coronary heart disease events in men: a cost-utility analysis.

Author information

  • 1University of North Carolina Division of General Internal Medicine, and RTI-University of North Carolina Center for Health Promotion Economics, Chapel Hill, North Carolina 27599-7110, USA. pignone@med.unc.edu

Abstract

BACKGROUND:

Aspirin and statins are both effective for primary prevention of coronary heart disease (CHD), but their combined use has not been well studied.

OBJECTIVE:

To perform a cost-utility analysis of the effects of aspirin therapy, statin therapy, combination therapy with both drugs, and no pharmacotherapy for the primary prevention of CHD events in men.

DESIGN:

Markov model.

DATA SOURCES:

Published literature.

TARGET POPULATION:

Middle-aged men without a history of cardiovascular disease at 6 levels of 10-year risk for CHD (2.5%, 5%, 7.5%, 10%, 15%, and 25%).

TIME HORIZON:

Lifetime.

PERSPECTIVE:

Third-party payer.

INTERVENTIONS:

Low-dose aspirin, a statin, both drugs as combination therapy, or no therapy.

OUTCOME MEASURE:

Cost per quality-adjusted life-year gained.

RESULTS OF BASE-CASE ANALYSIS:

For 45-year-old men who do not smoke, are not hypertensive, and have a 10-year risk for CHD of 7.5%, aspirin was more effective and less costly than no treatment. The addition of a statin to aspirin therapy produced an incremental cost-utility ratio of 56,200 dollars per quality-adjusted life-year gained compared with aspirin alone.

RESULTS OF SENSITIVITY ANALYSIS:

Excess risk for hemorrhagic stroke and gastrointestinal bleeding with aspirin, risk for CHD, the cost of statins, and the disutility of taking medication had important effects on the cost-utility ratios.

LIMITATIONS:

Several input parameters, particularly adverse event rates and utility values, are supported by limited empirical data. Results are applicable to middle-aged men only.

CONCLUSIONS:

Compared with no treatment, aspirin is less costly and more effective for preventing CHD events in middle-aged men whose 10-year risk for CHD is 7.5% or higher. The addition of a statin to aspirin therapy becomes more cost-effective when the patient's 10-year CHD risk before treatment is higher than 10%.

PMID:
16520473
[PubMed - indexed for MEDLINE]
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