title: 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: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Melbourne EpiCentre, Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Australia. zademi@unimelb.edu.au
authors: Zanfina
authors: Z
authors: Ademi
authors: Danny
authors: D
authors: Liew
authors: Bruce
authors: B
authors: Hollingsworth
authors: Ph Gabriel
authors: PG
authors: Steg
authors: Deepak L
authors: DL
authors: Bhatt
authors: Christopher M
authors: CM
authors: Reid
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D001241:Aspirin / Q000009:adverse effects / Q000191:economics*; D001315:Australia; D002318:Cardiovascular Diseases / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000191:economics; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics; D011322:Primary Prevention / Q000191:economics*; D012042:Registries; D055502:Secondary Prevention / Q000191:economics*; D013997:Time Factors; D035501:Uncertainty
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin