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


METHODS
Markov model.


METHODS
Published literature.


METHODS
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%).


METHODS
Lifetime.


CONCLUSIONS
Third-party payer.


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


METHODS
Cost per quality-adjusted life-year gained.


RESULTS
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
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.


CONCLUSIONS
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%.
Pignone
Michael
M
University 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
Earnshaw
Stephanie
S
Tice
Jeffrey A
JA
Pletcher
Mark J
MJ
D001241:Aspirin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003198:Computer Simulation; D003327:Coronary Disease / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011322:Primary Prevention; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000139:chemically induced
D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin