Abstract
Objective: to analyse the economic benefits, in comparison with placebo, of the secondary prevention of ischaemic stroke and myocardial infarction (MI) with lysine acetylsalicylate (Kardégic®) in patients with a history of ischaemic stroke, MI or stable and unstable angina pectoris.
Design and setting: This was a modelling study from the perspectives of direct medical costs, the social security system and society in France.
Methods: Efficacy data for the secondary prevention of ischaemic events were derived from the Antiplatelet Trialists’ Collaboration meta-analysis on antithrombotics. The rates and costs of ischaemic disease and of serious gastrointestinal adverse affects arising from long term aspirin treatment, as well as the costs of treatment with lysine acetylsalicylate, were taken from published sources, using French data where possible.
Results: From the social security perspective, the estimated cost-effectiveness ratios show that the prevention of MI in patients with a history of unstable angina (with a 1-year follow-up) is a cost-saving strategy, with net benefits ranging from $US5703 (1996 prices) per avoided MI for lysine acetylsalicylate 300 mg/day to $US5761 per avoided MI for lysine acetylsalicylate 75 mg/day. The prevention of MI and stroke is also a cost-saving strategy in patients with prior MI [net benefits in a 2-year follow-up (5% discount rate) ranging from $US15 to $US494 per avoided MI and from $US37 to $US1170 per avoided stroke]. This was also true in patients with prior ischaemic stroke (net benefits in a 3-year follow-up ranging from $US610 to $US2082 per avoided MI and from $US176 to $US599 per avoided stroke). Finally, a 4-year follow-up in patients with a history of stable angina pectoris shows that prophylactic treatment with lysine acetylsalicylate is associated with net costs per avoided MI, ranging from $US4375 to $US3608 per avoided event. Sensitivity analysis confirmed that prophylaxis with lysine acetylsalicylate in patients at high risk of cardiovascular and cerebrovascular events results in savings in social security expenditure.
Conclusions: Our results underline the high economic benefit of using lysine acetylsalicylate to prevent secondary ischaemic stroke and MI in patients at high risk of cardiovascular and/or cerebrovascular events, leading to savings for the social security system and society.
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References
The Diabetes Control and Complications Trial Research Group. Lifetime benefits and costs of intensive therapy as practiced in the Diabetes Control and Complications Trial. JAMA1996; 276: 1409–15
Eastman RC, Javitt JC, Herman WH, et al. Model of complications of NIDDM. II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care 1997; 20: 735–44
Henke CJ, Burchmore MJ. The economic impact of tacrine in the treatment of Alzheimer’s disease. Clin Ther 1997; 19: 330–45
Wimo A, Karlsson G, Nordberg A, et al. Treatment of Alzheimer disease with tacrine: a cost-analysis model. Alzheimer Dis Assoc Disord 1997; 11 (4): 191–200
O’Brien BJ, Goeree R, Hux M, et al. Economic evaluation of donepezil for the treatment of Alzheimer’s disease in Canada. J Am Geriatr Soc 1999; 47 (5): 570–8
Small GW, Donohue JA, Brooks RL. An economic evaluation of donepezil in the treatment of Alzheimer’s disease. Clin Ther 1998; 20 (4): 838–50
Fenn P, Gray A. Estimating long term cost savings from treatment of Alzheimer’s disease: a modelling approach. Pharmacoeconomics 1999; 16 (2): 165–74
Caro J, Klittich W, McGuire, et al. The West Of Scotland COronary Prevention Study: economic benefit analysis of primary prevention with pravastatin in WOSCOPS. BMJ 1997; 315: 1577–82
Pedersen TR, Kjekshus J, Berg K, et al. Cholesterol lowering and the use of healthcare resources: results of the Scandinavian Simvastatin Survival Study. Circulation 1996; 93: 1796–802
Johannesson M, Jöhnsson B, Kjekshus J, et al. Cost-effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. N Engl J Med 1997; 336: 332–6
Van Bergen PFMM, Jonker JJC, van Hout BA, et al. Costs and effects of long-term oral anticoagulant treatment after MI. JAMA 1995; 273 (12): 925–8
Scott G, Scott HM. Application of the findings of the European Stroke Prevention Study 2 (ESPS-2) to a NewZealand ischaemic stroke cost analysis. Pharmacoeconomics 1997; 12: 667–74
Evers SMA, Engel GL, Ament AJH. Cost of stroke in The Netherlands from a societal perspective. Stroke 1997; 28: 1375–81
Russell MW, Huse DM, Drowns S, et al. Direct medical costs of coronary artery disease in the United States. Am J Cardiol 1998; 81: 1110–5
Sagmeister M, Gessner U, Oggier W, et al. An economic analysis of ischaemic heart disease in Switzerland. Eur Heart J 1997; 18: 1102–9
Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet therapy - I: prevention of death, MI, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994; 308: 81–106
GiroudM,Milan C, Beuriat P, et al. Incidence and survival rates during a two-year period, of intracerebral and subarachnoid haemorrhages, cortical infarcts, lacunes and transient ischaemic attacks: the stroke registry of Dijon. Int J Epidemiol 1991; 20: 892–9
Federation Francaise de Cardiologie. Les registres français des cardiopathies ischémiques. L’infarctus du myocarde: données des trois registres des cardiopathies ischémiques de Lille, Strasbourg et Toulouse. Paris: Federation Francaise de Cardiologie, 1996
Murray CJL, Lopez AD. Global health statistics: WHO global burden of disease and injury series. Geneva: World Health Organization, 1996
Task Force of the European Society of Cardiology. Management of stable angina pectoris. Eur Heart J 1997; 18: 394–413
Goldberg M, Leclerc A, editors. Cohorte GAZEL: 20 000 volontaires d’EDF-GDF pour la recherche médicale. Paris: Editions INSERM, Collection Grandes Enquêtes, 1994
RISC Group. Risk of MI and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 1990; 336: 827–30
Wallentin LD, Research Group on Instability in Coronary Artery Disease in Southeast Sweden (RISC). Aspirin (75 mg/day) after an episode of unstable coronary artery disease: long-term effects on the risk for MI, occurrence of severe angina and the need for revascularization. J Am Coll Cardiol 1991; 18: 1587–93
Nyman I, Larsson H, Wallentin L, et al. Prevention of serious cardiac events by low-dose aspirin in patients with silent MI. Lancet 1992; 340: 497–501
Juul-Moller S, Edvardsson N, Jahnmatz B, et al. Double-blind trial of aspirin in primary prevention of MI in patients with stable chronic angina pectoris. Lancet 1992; 340: 1421–5
Elwood PC, Sweetnam PM. Aspirin and secondary mortality after MI. Circulation 1980; 62: 53–8
Elwood PC. Trial of acetylsalicylic acid in the secondary prevention of mortality from MI [letter]. BMJ 1981; 282: 481
Breddin K, Loew D, Lechner K, et al. Secondary prevention of MI: a comparison of acetylsalicylic acid, placebo and phenprocoumon. Haemostasis 1980; 9: 325–44
Breddin K, Loew D, Lechner K, et al. The German-Austrian aspirin trial: a comparison of acetylsalicylic acid, placebo and phenprocoumon in the secondary prevention of MI. Circulation 1980; 62: 63–72
Coronary Drug Project (CDP) Research Group. The coronary drug project: design, methods and baseline results. Circulation 1973: 47 Suppl. 1: 1–49
Coronary Drug Project (CDP) Research Group. Aspirin in coronary heart disease. J Chronic Dis 1976: 29: 625–42
Coronary Drug Project (CDP) Research Group. Aspirin in coronary heart disease. Circulation 1980: 62 Suppl. 5: 59–62
Vogel G, Fischer C, Huyke R. Prevention of reinfarction with acetylsalicylic acid. In: Breddin K, Loew D, Uberla K, et al., editors. Prophylaxis of venous peripheral cardiac and cerebral vascular diseases with acetylsalicylic acid. Stuttgart: Shattauer, 1981: 123–8
Aspirin MI Study (AMIS) Research Group. AMIS: a randomized controlled trial of aspirin in persons recovered from MI. JAMA 1980; 243: 661–9
Aspirin MI Study (AMIS) Research Group. AMIS: the aspirin MI study: final results. Circulation 1980; 62 Suppl. 5: 79–84
Fields WS, Lemak NA, Frankowski RF, et al. Controlled trial of aspirin in cerebral ischemia. Stroke 1977; 8: 301–14
Fields WS, Lemak NA, Frankowski RF, et al. Controlled trial of aspirin in cerebral ischemia. Pt II: surgical group. Stroke 1978; 9: 309–18
Lemak NA, Fields WS, Gary Jr HE. Controlled trial of aspirin in cerebral ischemia: an addendum. Neurology 1986; 36: 705–10
Boysen G, Soelberg-Sorensen P, Juhker M, et al. Danish very low- dose aspirin after carotid endarterectomy trial. Stroke 1988; 19: 1211–5
Reuther R, Dorndorf W. Aspirin in patients with cerebral ischemia and normal angiograms or non-surgical lesions. In: Breddin K, Dorndorf W, Loew D, et al., editors. Acetylsalicylic acid in cerebral ischemia and coronary heart disease. Stuttgart: Shattauer, 1978: 97–106
Britton M, Helmers C, Samuelsson K. High-dose acetylsalicylic acid after cerebral infarction: a Swedish co-operative study. Stroke 1987; 18: 325–34
SALT Collaborative Group. Swedish aspirin low-dose trial (SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events. Lancet 1991; 338: 1345–9
Sorensen PS, Pedersen H,Marquardsen J, et al. Acetylsalicylic acid in the prevention of stroke in patients with reversible cerebral ischaemic attacks: a Danish cooperative study. Stroke 1983; 14: 15–22
Bousser MG, Eschwege E, HaguenauM, et al. AICLA controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia. Stroke 1983; 14: 5–14
Bousser MG, Eschwege E, Haguenau M, et al. Essai coopératif contrôlé de prévention secondaire des accidents ischémiques cérébraux liés à l’athérosclérose par l’aspirine et le dipyridamole. Presse Med 1983; 12: 3049–57
UK-TIA Study Group. United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: interim results. BMJ 1988; 296: 316–20
UK-TIA Study Group. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 1991; 54: 1044–54
Creager MA. Results of the CAPRIE trial: efficacy and safety of clopidogrel: clopidogrel versus aspirin in patients at risk of ischaemic events. Vasc Med 1998; 3 (3): 257–60
Dippel DW. The results of CAPRIE, IST and CAST. Clopidogrel vs. Aspirin in Patients at Risk of Ischaemic Events. International Stroke Trial. Chinese Acute Stroke Trial. Thromb Res 1998; 92 (1 Suppl. 1): S13–6
SPIRIT study group. A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin: the Stroke Prevention Reversible Ischemia Trial (SPIRIT) Study. Ann Neurol 1997; 42 (6): 857–65
CARS study group. Randomised double-blind trial of fixed low-dose warfarin with aspirin after MI: Coumadin Aspirin Reinfarction Study (CARS) investigators. Lancet 1997; 350 (9075): 389–96
SPAF III study group. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrilation: stroke prevention in atrial fibrilation III randomised clinical trial. Lancet 1996; 348 (9028): 633–8
Meschengieser SS, Fondevilla CG, Frontroth J, et al. Low-intensity anticoagulation plus low-dose aspirin versus high-intensity oral anticoagulation alone: a randomized trial in patients with mechanical prosthetic heart valves. J Thorac Cardiovasc Surg 1997; 113 (5): 910–6
Roderick PJ, Wilkes HC, Meade TW. The gastrointestinal toxicity of aspirin: an overview of randomised controlled trials. Br J Clin Pharmacol 1993; 35: 219–26
Ministère des Affaires Sociales, de la Santé et de la Ville. L’échelle nationale des coûts relatifs par Groupe Homogène de Malades 1995. Paris: Ministère des Affaires Sociales, de la Santé et de la Ville, 1996
Lévy E, Le Pen C. Le coût des maladies vasculaires cérébrales non hémorragiques. In: Rancurel G, editor. La prévention des accidents ischémiques cérébraux. Paris: Sanofi Wintrop, 1994: 245–56
Lecomte T. Evolution de la morbidité déclarée. France 1970- 1980. Paris: Centre de Recherche et de Documentation en Economie de la Santé (CREDES), 1986
Castiel D, Herve C, Gaillard M. Devenir socio-professionnel des patients traités pour infarctus du myocarde. Cah Sociol Demogr Med 1991; 31: 167–81
Castiel D, Herve C, Gaillard M, et al. Incidence du niveau de revenu chez des patients atteints d’infarctus du myocarde et thrombolysés. J d’Econ Med 1993; 11: 45–53
Garber AM, Phelps CE. Economic foundations of cost-effectiveness analysis. Working paper 4164. Cambridge (MA): National Bureau of Economic Research, 1992
Garber AM, Phelps CE. Economic foundations of cost-effectiveness analysis. J Health Econ 1997; 16: 1–31
Arnau JM, Agusti A. Is aspirin underused in myocardial infarction? Pharmacoeconomics 1997; 12: 524–32
American Society of Health System Pharmacists. ASHP therapeutic position statement on the use of aspirin for prophylaxis of MI. Am J Health Syst Pharm 1997; 54 (17): 1984–7
Weinstein MC, Manning WG. Theoretical issues in cost-effectiveness analysis. J Health Econ 1997; 16: 121–8
Meltzer D. Accounting for future costs in medical cost-effectiveness analysis. J Health Econ 1997; 16: 33–64
Bonneux L, Barendregt JJ, Nusselder WJ, et al. Preventing fatal diseases increases healthcare costs: cause elimination life table approach. BMJ 1998; 316: 26–9
Hoehn JP, Randall A. Too many proposals pass the benefit cost test. Am Econ Rev 1989; 79: 544–51
Birch S, Gafni A. Cost effectiveness/utility analyses. Do current decision rules lead us to where we want to be? J Health Econ 1992; 11: 279–96
Johannesson M, Weinstein MC. On the decision rules of cost-effectiveness analysis. J Health Econ 1993; 12: 459–67
Birch S, Gafni A. Changing the problem to fit the solution: Johannesson and Weinstein’s (mis) application of economics to real world problems. J Health Econ 1993; 12: 469–76
Whitford DL, Southern AJ. Audit of secondary prophylaxis after MI. BMJ 1994; 309: 1268–9
Meehan TP, Hennen J, Radford MJ, et al. Process and outcome of care for acute MI among Medicare beneficiaries in Connecticut: a quality improvement demonstration project. Ann Intern Med 1995; 122: 928–36
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This study received funding from Sanofi-Synthélabo France.
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Marissal, JP., Selke, B. & Lebrun, T. Economic Assessment of the Secondary Prevention of Ischaemic Events with Lysine Acetylsalicylate. Pharmacoeconomics 18, 185–200 (2000). https://doi.org/10.2165/00019053-200018020-00008
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DOI: https://doi.org/10.2165/00019053-200018020-00008