title: Cost-Effectiveness of a Statewide Campaign to Promote Aspirin Use for Primary Prevention of Cardiovascular Disease.
abstract: BACKGROUND
  The U.S. Preventive Services Task Force in 2009 recommended increased aspirin use for primary prevention of cardiovascular disease (CVD) in men ages 45 to 79 years and women ages 55 to 79 years for whom benefit outweighs risk. This study estimated the clinical efficacy and cost-effectiveness of a statewide public and health professional awareness campaign to increase regular aspirin use among the target population in Minnesota to reduce first CVD events.
  
  
  RESULTS
  A state-transition Markov model was developed, adopting a payer perspective and lifetime time horizon. The main outcomes of interest were quality-adjusted life years, costs, and the number of CVD events averted among those without a prior CVD history. The model was based on real-world data about campaign effectiveness from representative state-specific aspirin use and event rates, and estimates from the scholarly literature. Implementation of a campaign was predicted to avert 9874 primary myocardial infarctions in men and 1223 primary ischemic strokes in women in the target population. Increased aspirin use was associated with as many as 7222 more major gastrointestinal bleeding episodes. The cost-effectiveness analysis indicated cost-saving results for both the male and female target populations.
  
  
  CONCLUSIONS
  Using current U.S. Preventive Services Task Force recommendations, a state public and health professional awareness campaign would likely provide clinical benefit and be economically attractive. With clinician adjudication of individual benefit and risk, mechanisms can be made available that would facilitate achievement of aspirin's beneficial impact on lowering risk of primary CVD events, with minimization of adverse outcomes.
authors.affiliation: Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE (T.L.M.) Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE (T.L.M.).
authors.forename: Tzeyu L
authors.initials: TL
authors.lastname: Michaud
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, MN (J.A.).
authors.forename: Jean
authors.initials: J
authors.lastname: Abraham
authors.affiliation: Department of Health Policy and Management, University of Pittsburgh, PA (H.J.).
authors.forename: Hawre
authors.initials: H
authors.lastname: Jalal
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (R.V.L., A.T.H.) Lillehei Heart Institute and Cardiovascular Division, University of Minnesota, Minneapolis, MN (R.V.L., S.D., A.T.H.).
authors.forename: Russell V
authors.initials: RV
authors.lastname: Luepker
authors.affiliation: Lillehei Heart Institute and Cardiovascular Division, University of Minnesota, Minneapolis, MN (R.V.L., S.D., A.T.H.).
authors.forename: Sue
authors.initials: S
authors.lastname: Duval
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (R.V.L., A.T.H.) Lillehei Heart Institute and Cardiovascular Division, University of Minnesota, Minneapolis, MN (R.V.L., S.D., A.T.H.).
authors.forename: Alan T
authors.initials: AT
authors.lastname: Hirsch
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008910:Minnesota; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011322:Primary Prevention / Q000191:economics / Q000379:methods; D019057:Quality-Adjusted Life Years
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: aspirin; cardiovascular diseases; cost–effectiveness analysis; epidemiology; myocardial infarction; prevention; stroke