Effect of Including Cancer Mortality on the Cost-Effectiveness of Aspirin for Primary Prevention in Men
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Recent data suggest that aspirin may be effective for reducing cancer mortality.
To examine whether including a cancer mortality-reducing effect influences which men would benefit from aspirin for primary prevention.
We modified our existing Markov model that examines the effects of aspirin among middle-aged men with no previous history of cardiovascular disease or diabetes. For our base case scenario of 45-year-old men, we examined costs and life-years for men taking aspirin for 10 years compared with men who were not taking aspirin over those 10 years; after 10 years, we equalized treatment and followed the cohort until death. We compared our results depending on whether or not we included a 22 % relative reduction in cancer mortality, based on a recent meta-analysis. We discounted costs and benefits at 3 % and employed a third party payer perspective.
Cost per quality-adjusted life year (QALY) gained.
When no effect on cancer mortality was included, aspirin had a cost per QALY gained of $22,492 at 5 % 10-year coronary heart disease (CHD) risk; at 2.5 % risk or below, no treatment was favored. When we included a reduction in cancer mortality, aspirin became cost-effective for men at 2.5 % risk as well (cost per QALY, $43,342). Results were somewhat sensitive to utility of taking aspirin daily; risk of death after myocardial infarction; and effects of aspirin on stroke, myocardial infarction, and sudden death. However, aspirin remained cost-saving or cost-effective (< $50,000 per QALY) in probabilistic analyses (59 % with no cancer effect included; 96 % with cancer effect) for men at 5 % risk.
Including an effect of aspirin on cancer mortality influences the threshold for prescribing aspirin for primary prevention in men. If such an effect is real, many middle-aged men at low cardiovascular risk would become candidates for regular aspirin use.
- Effect of Including Cancer Mortality on the Cost-Effectiveness of Aspirin for Primary Prevention in Men
Journal of General Internal Medicine
Volume 28, Issue 11 , pp 1483-1491
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- cancer mortality
- coronary heart disease
- guideline-based intervention
- primary prevention
- Industry Sectors
- Author Affiliations
- 1. Cecil Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
- 2. Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- 5. Department of Medicine, University of North California, 5045 Old Clinic Building UNC Hospital, Chapel Hill, NC, 27599-7110, USA
- 3. RTI Health Solutions, RTI International Research Triangle Park, RTP, NC, USA
- 4. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA