Journal of General Internal Medicine

, Volume 28, Issue 11, pp 1483–1491

Effect of Including Cancer Mortality on the Cost-Effectiveness of Aspirin for Primary Prevention in Men

  • Michael Pignone
  • Stephanie Earnshaw
  • Cheryl McDade
  • Mark J. Pletcher
Original Research

DOI: 10.1007/s11606-013-2465-6

Cite this article as:
Pignone, M., Earnshaw, S., McDade, C. et al. J GEN INTERN MED (2013) 28: 1483. doi:10.1007/s11606-013-2465-6



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 cancer mortality coronary heart disease guideline-based intervention primary prevention 

Supplementary material

11606_2013_2465_MOESM1_ESM.docx (232 kb)
ESM 1(DOCX 231 kb)

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Michael Pignone
    • 1
    • 2
    • 5
  • Stephanie Earnshaw
    • 3
  • Cheryl McDade
    • 3
  • Mark J. Pletcher
    • 4
  1. 1.Cecil Sheps Center for Health Services ResearchUniversity of North CarolinaChapel HillUSA
  2. 2.Lineberger Cancer CenterUniversity of North CarolinaChapel HillUSA
  3. 3.RTI Health Solutions, RTI International Research Triangle ParkRTPUSA
  4. 4.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  5. 5.Department of MedicineUniversity of North CaliforniaChapel HillUSA

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