title: Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk.
abstract: BACKGROUND
  Aspirin is effective for the primary prevention of cardiovascular events, but it remains unclear for which subgroups of individuals aspirin is beneficial. We assessed the cost-effectiveness of aspirin separately for men and women of different ages with various levels of cardiovascular disease risk.
  
  
  RESULTS
  A Markov model was developed to predict the number of cardiovascular events prevented, quality-adjusted life-years, and costs over a 10-year period. Event rates were taken from Dutch population data, and the relative effectiveness of aspirin was taken from a gender-specific meta-analysis. Sensitivity analyses and Monte Carlo simulations were conducted to evaluate the robustness of the results. In 55-year-old persons, aspirin prevented myocardial infarctions in men (127 events per 100,000 person-years) and ischemic strokes in women (17 events per 100,000 person-years). Aspirin implies a net investment and a quality-adjusted life-year gain in men 55 years of age; the incremental cost-effectiveness ratio was 111,949 euros per quality-adjusted life-year (1 euro=$1.27 as of June 2007). Aspirin was cost-effective for 55- and 65-year-old men with moderate cardiovascular risk and men 75 years of age (10-year cardiovascular disease risk >10%). Conversely, aspirin was beneficial for women 65 years of age with high cardiovascular risk and women 75 years of age with moderate cardiovascular risk (10-year cardiovascular disease risk >15%). Results were sensitive to drug treatment costs, effectiveness of aspirin treatment, and utility of taking aspirin.
  
  
  CONCLUSIONS
  Aspirin treatment for primary prevention is cost-effective for men with a 10-year cardiovascular disease risk of >10% and for women with a risk of >15%. This occurs much later in life for women than men. Therefore, opportunities for the primary prevention of aspirin seem limited in women, and a differentiated preventive strategy seems warranted.
authors.affiliation: Julius Center for Health Sciences and Primary Care, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands. J.P.Greving@umcutrecht.nl
authors.forename: Jacoba P
authors.initials: JP
authors.lastname: Greving
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
authors.forename: Hendrik
authors.initials: H
authors.lastname: Koffijberg
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
mesh_terms: D000367:Age Factors; D000368:Aged; D001241:Aspirin / Q000191:economics* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D011322:Primary Prevention / Q000379:methods*; D018570:Risk Assessment; D012737:Sex Factors
chemical_list: D001241:Aspirin