title: The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older.
abstract: BACKGROUND
  The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease.
  
  
  RESULTS
  We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011-2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08-0.50) and would add 900,000 people (95% CI 300,000-1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345-975) in net health benefits over that period.
  
  
  CONCLUSIONS
  Expanded use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively.
authors.affiliation: Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California Keck School of Medicine and Viterbi School of Engineering, Beverly Hills, California, United States of America.
authors.forename: David B
authors.initials: DB
authors.lastname: Agus
authors.affiliation: Schaeffer Center for Health Policy and Economics, University of Southern California Price School and School of Pharmacy, Los Angeles, California, United States of America.
authors.forename: Étienne
authors.initials: É
authors.lastname: Gaudette
authors.affiliation: Schaeffer Center for Health Policy and Economics, University of Southern California Price School and School of Pharmacy, Los Angeles, California, United States of America.
authors.forename: Dana P
authors.initials: DP
authors.lastname: Goldman
authors.affiliation: Analysis Group, Inc. Boston, Massachusetts, United States of America.
authors.forename: Andrew
authors.initials: A
authors.lastname: Messali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011322:Primary Prevention; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin