Is It Cost‐Effective To Increase Aspirin Use in Outpatient Settings for Primary or Secondary Prevention? Simulation Data from the REACH Registry Australian Cohort

Abstract

SUMMARYAims: To describe aspirin use in primary and secondary prevention and to determine the incremental costs-effectiveness ratio (ICER) per life year gain (LYG) of aspirin use among subjects with, or at high risk of atherothrombotic disease. Design and Subjects: To project the cost-effectiveness of aspirin over 5 years of follow-up, a Markov state transition model was developed with yearly cycles and the following health states: "Alive" (post-CAD) and "Dead." The model compared current coverage observed among 2361 subjects using the prospective Australian subset of Reduction of Atherothrombosis for continued Health (REACH) registry, and hypothetical situation whereby all subjects assumed to be treated. Costs were calculated based on the Australian government reimbursed data for 2010. Main outcome measures: ICER per LYG for increased use of aspirin. Results: The use of aspirin in current group varied from 67% to 70%. The base-case analysis showed that increasing aspirin use among subjects with existing CAD in outpatient settings was cost saving, while increasing use of aspirin in primary prevention equated to an ICER of AUD 7126 per LYG. Conclusion: Among subjects with existing CAD aspirin use was shown to be a dominant choice of treatment. However, among patients without existing cardiovascular disease (primary prevention), increased uptake of aspirin was cost effective but with uncertain benefit, with two hemorrhagic bleeding events occurring for every life saved.

Use of Low-Dose Aspirin as Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults (from the National Health Interview Survey, 2012)

“…2 In addition to the health benefits found with the use of low-dose aspirin for secondary prevention, other studies have found the recommendations to be cost-effective and to have significant economic benefits. 16 Current American Heart Association and the American College of Cardiology guidelines strongly recommend aspirin use for survivors of acute myocardial infarctions or those with coronary or other atherosclerotic vascular disease to prevent event recurrence or death. 345 …”

All-cause mortality following low-dose aspirin treatment for patients with high cardiovascular risk in remote Australian Aboriginal communities: an observational study

“…A meta-analysis of patients with type 2 diabetes but no prior cardiovascular disease showed a modest 10% reduction in major cardiovascular events but no reduction in mortality 36. In a study in Australia, aspirin was found cost-effective in primary and secondary prevention 37. Moreover, in a recent randomised controlled trial of 15 480 Caucasians with diabetes (mean age 63 years) but no evidence of cardiovascular disease, 100 mg of aspirin over the follow-up of 7.4 years reduced the cardiovascular event rate by 12% but increased the risk of major bleedings by 29% 38.…”

Benefit-harm analysis and charts for individualized and preference-sensitive prevention: example of low dose aspirin for primary prevention of cardiovascular disease and cancer

“…Finally, outcome risks, evidence on treatment effects, and preferences may change over time. For example, there are ongoing studies (ASPREE, ARRIVE, ASCEND, ACCEPT-D) that assess the effects of aspirin in diverse settings and populations as well as cost effectiveness [ 48 , 49 ]. Technically, it is not difficult to update benefit-harm analyses such as the ones presented here with additional evidence.…”