Analysis of aspirin-associated risks in healthy individuals.
BACKGROUND
Aspirin therapy is widely accepted for patients with documented cardiovascular disease, but there is a growing trend among healthy individuals to use aspirin as primary prevention for both cardiovascular disease and cancer.


OBJECTIVE
To determine the impact of the complications of aspirin therapy on quality-adjusted life-years (QALYs) in healthy individuals.


METHODS
A computer-based decision-analytic model was constructed. In this model, healthy individuals taking aspirin were assumed to receive no advantages from the aspirin, but were at risk of developing its associated complications. Individuals took 325 mg of enteric-coated aspirin every day until death, discontinuing therapy only if an aspirin-induced complication occurred. The analysis was performed from a societal perspective, starting at age 50 years. Extensive sensitivity analyses were performed.


RESULTS
In the absence of any beneficial effect, aspirin reduced QALYs by 0.03 per individual. Unadjusted life expectancy was decreased by 0.04 years (2 wk). Lifetime aspirin use cost an average of $460/healthy person. The total complication rate over a lifetime of aspirin therapy was 6.79%, with a mortality rate of 0.18%. Alternatively stated, there was one complication for every 15 individuals treated and one death for every 556 individuals treated. Extensive sensitivity analysis showed the range of results possible when varying age, gender, length of follow-up, and other key parameters.


CONCLUSIONS
Assuming no benefits, aspirin therapy in healthy individuals leads to a small reduction in QALYs at an overall low cost per person. However, approximately 1 in 15 individuals will experience an aspirin-induced complication and 1 in 556 individuals will die.
Hur
Chin
C
Harvard Medical School, Institute for Technology Assessment and Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA 02114-4719, USA. chur@mgh-ita.org
Simon
Lee S
LS
Gazelle
G Scott
GS
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000191:economics; D001241:Aspirin / Q000009:adverse effects* / Q000191:economics; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012680:Sensitivity and Specificity
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin