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.
- Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373: pp. 1849-60 CrossRef
- Berger, JS, Roncaglioni, MC, Avanzini, F, Pangrazzi, I, Tognoni, G, Brown, DL (2006) Aspirin for the primary prevention of cardiovascular events in women and men: asex-specific meta-analysis of randomized controlled trials. JAMA 295: pp. 306-13 CrossRef
- Hernandez-Diaz, S, Garcia Rodriquez, LA (2006) Cardioprotective aspirin users and their excess risk of upper gastrointestinal complications. BMC Med. 4: pp. 22 CrossRef
- Berardis, G, Lucisano, G, D’Ettorre, A (2012) Association of aspirin use with major bleeding in patients with and without diabetes. JAMA 307: pp. 2286-94 CrossRef
- Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 150: pp. 396-404 CrossRef
- Berger, JS, Lala, A, Krantz, MJ, Baker, GS, Hiatt, WR (2011) Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials. Am Heart J 162: pp. 115-24.e2 CrossRef
- Raju, N, Sobieraj-Teague, M, Hirsh, J, O’Donnell, M, Eikelboom, J (2011) Effect of aspirin on mortality in the primary prevention of cardiovascular disease. Am J Med 124: pp. 621-9 CrossRef
- Sanmuganathan, PS, Ghahramani, P, Jackson, PR, Wallis, EJ, Ramsay, LE (2001) Aspirin for primary prevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from meta-analysis of randomised trials. Heart 85: pp. 265-271 CrossRef
- Seshasai, SR, Wijesuriya, S, Sivakumaran, R (2012) Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med 172: pp. 209-16 CrossRef
- Pignone, M, Earnshaw, S, Tice, JA, Pletcher, MJ (2006) Aspirin, statins, or both drugs for the primary prevention of coronary heart disease events in men: a cost-utility analysis. Ann Intern Med 144: pp. 326-36 CrossRef
- Earnshaw, SR, Scheiman, J, Fendrick, AM, McDade, C, Pignone, M (2011) Cost-utility of aspirin and proton pump inhibitors for primary prevention. Arch Intern Med 171: pp. 218-25 CrossRef
- Greving, JP, Buskens, E, Koffijberg, H, Algra, A (2008) Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk. Circulation 117: pp. 2875-83 CrossRef
- Rothwell, PM, Fowkes, FG, Belch, JF, Ogawa, H, Warlow, CP, Meade, TW (2011) Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet 377: pp. 31-41 CrossRef
- Chan, AT, Cook, NR (2012) Are we ready to recommend aspirin for cancer prevention?. Lancet 379: pp. 1569-71 CrossRef
- Pignone, M, Earnshaw, S, Pletcher, MJ, Tice, JA (2007) Aspirin for the primary prevention of cardiovascular disease in women: a cost-utility analysis. Arch Intern Med 167: pp. 290-5 CrossRef
- Lampe, FC, Whincup, PH, Wannamethee, SG, Shaper, AG, Walker, M, Ebrahim, S (2000) The natural history of prevalent ischaemic heart disease in middleaged men. Eur Heart J 21: pp. 1052-62 CrossRef
- Dennis, MS, Burn, JP, Sandercock, PA, Bamford, JM, Wade, DT, Warlow, CP (1993) Long term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke 24: pp. 796-800 CrossRef
- Anderson, KM, Odell, PM, Wilson, PWF, Kannel, WB (1991) Cardiovascular disease risk profiles. Am Heart J 121: pp. 293-8 CrossRef
- Kung, HC, Hoyert, DL, Xu, JQ, Murphy, SL (2008) Deaths: Final Data for 2005. National Vital Statistics Reports; vol 56 no 10. National Center for Health Statistics, Hyattsville, MD
- Surveillance, Epidemiology, and End Results Program. SEER*Stat Database: Mortality - All COD, Aggregated With State, Total U.S. (1969-2007), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2009. Available at: www.seer.cancer.gov. Accessed on September 8, 2011.
- Leerdam, ME, Vreeburg, EM, Rauws, EA (2003) Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 98: pp. 1494-9 CrossRef
- Rockall, TA, Logan, RF, Devlin, HB, Northfield, TC (1995) Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom: Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 311: pp. 222-226 CrossRef
- Rothwell, PM, Price, JF, Fowkes, FG (2012) Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet 379: pp. 1602-12 CrossRef
- He, J, Whelton, PK, Vu, B, Klag, MJ (1998) Aspirin and risk of hemorrhagic stroke. JAMA 280: pp. 1930-5 CrossRef
- LaRosa, JC, He, J, Vupputuri, S (1999) Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 282: pp. 2340-6 CrossRef
- Meara, E, White, C, Cutler, DM (2004) Trends in medical spending by age, 1963-2000. Health Aff (Millwood) 23: pp. 176-183 CrossRef
- Lubitz, J, Cai, L, Kramarow, E, Lentzner, H (2003) Health, life expectancy, and health care spending among the elderly. N Engl J Med 349: pp. 1048-1055 CrossRef
- U.S. Department of Labor, U.S. Bureau of Labor Statistics, US city average, not seasonally adjusted medical care. http://data.bls.gov/PDQ/outside.jsp?survey=cu. Accessed February 2012.
- Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 Patients. Am J Med. 2012 Jun 27.[Epub ahead of print] PubMed PMID: 22748400.
- Hayden, M, Pignone, M, Phillips, C, Mulrow, C (2002) Aspirin for the primary prevention of cardiovascular events: a summary of the evidence for the US preventive services task force. Ann Intern Med 136: pp. 61-172 CrossRef
- Straube, S, Tramèr, MR, Moore, RA, Derry, S, McQuay, HJ (2009) Mortality with upper gastrointestinal bleeding and perforation: effects of time and NSAID use. BMC Gastroenterol 9: pp. 41 CrossRef
- www.Walgreens.com, accessed 9Sep11.
- Ingenix, Inc. The Essential RBRVS (2012): A comprehensive listing of RBRVS values for CPT and HCPCS Codes. St. Anthony Publishing, 2012.
- HCUPnet. Healthcare Cost and Utilization Project (HCUP). 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/HCUPnet/ Accessed 7Mar2012.
- Friedman, B, Mare, J, Andrews, R, McKenzie, DH (2002) Assuming an average cost to charge ratio of 0.5: practical options for estimating cost of hospital inpatient stays. J Health Care Finance 29: pp. 1-13
- Russell, MW, Huse, DM, Drowns, S, Hamel, EC, Hartz, SC (1998) Direct medical costs of coronary artery disease in the United States. Am J Cardiol 81: pp. 1110-5 CrossRef
- Roger, VL, Go, AS, Lloyd-Jones, DM (2011) Heart disease and stroke statistics - 2011 Update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 123: pp. e18-e209 CrossRef
- Leibson, CL, Hu, T, Brown, RD, Hass, SL, O’Fallon, WM, Whisnant, JP (1996) Utilization of acute care services in the year before and after first stroke: A population-based study. Neurology 46: pp. 1-13
- Menzin, J, Wygant, G, Hauch, O, Jackel, J, Friedman, M (2008) One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database. Curr Med Res Opin 24: pp. 461-468 CrossRef
- Augustovski, FA, Cantor, SB, Thach, CT, Spann, SJ (1998) Aspirin for primary prevention of cardiovascular events. J Gen Intern Med 13: pp. 824-35 CrossRef
- Nease, RF, Kneeland, T, O’Connor, GT (1995) Variation in patient utilities for outcomes of the management of chronic stable angina. JAMA 273: pp. 1185-90 CrossRef
- Gore, JM, Granger, CB, Simoons, ML, Sloan, MA, Weaver, WD, White, HD (1995) Stroke after thrombolysis: mortaltiy and functional outcomes in the GUSTO-I trial. Circulation 92: pp. 2811-8 CrossRef
- Tsevat, J, Goldman, L, Soukup, JR (1993) Stability of time-tradeoff utilities in survivors of myocardial infarction. Med Decis Making 13: pp. 161-5 CrossRef
- 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