Format

Send to

Choose Destination
See comment in PubMed Commons below
J Gen Intern Med. 2013 Nov;28(11):1483-91. doi: 10.1007/s11606-013-2465-6. Epub 2013 May 17.

Effect of including cancer mortality on the cost-effectiveness of aspirin for primary prevention in men.

Author information

1
Cecil Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA, pignone@med.unc.edu.

Abstract

BACKGROUND:

Recent data suggest that aspirin may be effective for reducing cancer mortality.

OBJECTIVE:

To examine whether including a cancer mortality-reducing effect influences which men would benefit from aspirin for primary prevention.

DESIGN:

We modified our existing Markov model that examines the effects of aspirin among middle-aged men with no previous history of cardiovascular disease or diabetes. For our base case scenario of 45-year-old men, we examined costs and life-years for men taking aspirin for 10 years compared with men who were not taking aspirin over those 10 years; after 10 years, we equalized treatment and followed the cohort until death. We compared our results depending on whether or not we included a 22 % relative reduction in cancer mortality, based on a recent meta-analysis. We discounted costs and benefits at 3 % and employed a third party payer perspective.

MAIN MEASURE:

Cost per quality-adjusted life year (QALY) gained.

KEY RESULTS:

When no effect on cancer mortality was included, aspirin had a cost per QALY gained of $22,492 at 5 % 10-year coronary heart disease (CHD) risk; at 2.5 % risk or below, no treatment was favored. When we included a reduction in cancer mortality, aspirin became cost-effective for men at 2.5 % risk as well (cost per QALY, $43,342). Results were somewhat sensitive to utility of taking aspirin daily; risk of death after myocardial infarction; and effects of aspirin on stroke, myocardial infarction, and sudden death. However, aspirin remained cost-saving or cost-effective (< $50,000 per QALY) in probabilistic analyses (59 % with no cancer effect included; 96 % with cancer effect) for men at 5 % risk.

CONCLUSIONS:

Including an effect of aspirin on cancer mortality influences the threshold for prescribing aspirin for primary prevention in men. If such an effect is real, many middle-aged men at low cardiovascular risk would become candidates for regular aspirin use.

PMID:
23681842
PMCID:
PMC3797356
DOI:
10.1007/s11606-013-2465-6
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Springer Icon for PubMed Central
    Loading ...
    Support Center