Aspirin, Statins, or Both Drugs for the Primary Prevention of Coronary Heart Disease Events in Men: A Cost–Utility Analysis

  1. Michael Pignone, MD, MPH;
  2. Stephanie Earnshaw, PhD;
  3. Jeffrey A. Tice, MD; and
  4. Mark J. Pletcher, MD, MPH
  1. From University of North Carolina and RTI–University of North Carolina Center for Health Promotion Economics, Chapel Hill, North Carolina; RTI Health Solutions, Research Triangle Park, North Carolina; and University of California, San Francisco, California.

    Abstract

    Background: Aspirin and statins are both effective for primary prevention of coronary heart disease (CHD), but their combined use has not been well studied.

    Objective: To perform a cost–utility analysis of the effects of aspirin therapy, statin therapy, combination therapy with both drugs, and no pharmacotherapy for the primary prevention of CHD events in men.

    Design: Markov model.

    Data Sources: Published literature.

    Target Population: Middle-aged men without a history of cardiovascular disease at 6 levels of 10-year risk for CHD (2.5%, 5%, 7.5%, 10%, 15%, and 25%).

    Time Horizon: Lifetime.

    Perspective: Third-party payer.

    Interventions: Low-dose aspirin, a statin, both drugs as combination therapy, or no therapy.

    Outcome Measure: Cost per quality-adjusted life-year gained.

    Results of Base-Case Analysis: For 45-year-old men who do not smoke, are not hypertensive, and have a 10-year risk for CHD of 7.5%, aspirin was more effective and less costly than no treatment. The addition of a statin to aspirin therapy produced an incremental cost–utility ratio of $56 200 per quality-adjusted life-year gained compared with aspirin alone.

    Results of Sensitivity Analysis: Excess risk for hemorrhagic stroke and gastrointestinal bleeding with aspirin, risk for CHD, the cost of statins, and the disutility of taking medication had important effects on the cost–utility ratios.

    Limitations: Several input parameters, particularly adverse event rates and utility values, are supported by limited empirical data. Results are applicable to middle-aged men only.

    Conclusions: Compared with no treatment, aspirin is less costly and more effective for preventing CHD events in middle-aged men whose 10-year risk for CHD is 7.5% or higher. The addition of a statin to aspirin therapy becomes more cost-effective when the patient's 10-year CHD risk before treatment is higher than 10%.

    Article and Author Information

    • Acknowledgments: The authors thank Evan Sloan for his assistance in preparation of the manuscript and Sumeet Patil and Chris Graham for their assistance with developing the figures and tables.

    • Grant Support: By Bayer (Dr. Pignone) and by grant number 1P30CD000138-01 from the Centers for Disease Control and Prevention (Dr. Pignone).

    • Potential Financial Conflicts of Interest: Consultancies: M. Pignone (Bayer, Pfizer Inc.); Honoraria: M. Pignone (Bayer, Pfizer Inc.); Expert testimony: M. Pignone (Bayer); Grants received: M. Pignone (Bayer), S. Earnshaw (Bayer); Other: M. Pignone (Bayer).

    • Requests for Single Reprints: Michael Pignone, MD, MPH, University of North Carolina Division of General Internal Medicine, 5039 Old Clinic Building, UNC Hospital, Chapel Hill, NC 27599-7110; e-mail, pignone{at}med.unc.edu.

    • Current Author Addresses: Dr. Pignone: University of North Carolina Division of General Internal Medicine, 5039 Old Clinic Building, UNC Hospital, Chapel Hill, NC 27599-7110.

    • Dr. Earnshaw: RTI Health Solutions, P.O. Box 12194, Research Triangle Park, NC 27709.

    • Dr. Tice: Department of Medicine, University of California, San Francisco, 1701 Divisadero Street, San Francisco, CA 94143-1732.

    • Dr. Pletcher: Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry Street, Lobby 4, Suite 5700, San Francisco, CA 94107.

    • Author Contributions: Conception and design: M. Pignone, S. Earnshaw, J.A. Tice, M.J. Pletcher.

    • Analysis and interpretation of the data: M. Pignone, S. Earnshaw, J.A. Tice, M.J. Pletcher.

    • Drafting of the article: M. Pignone, S. Earnshaw.

    • Critical revision of the article for important intellectual content: M. Pignone, S. Earnshaw, J.A. Tice, M.J. Pletcher.

    • Final approval of the article: M. Pignone, S. Earnshaw, J.A. Tice, M.J. Pletcher.

    • Provision of study materials or patients: S. Earnshaw.

    • Statistical expertise: S. Earnshaw, M.J. Pletcher.

    • Administrative, technical, or logistic support: M. Pignone, S. Earnshaw.

    • Collection and assembly of data: S. Earnshaw.

    Responses to this article

    • Response to letter from Dr. Chelmowski
      • Michael Pignone
      Ann Intern Med published online October 26, 2009
    • cost effectiveness of statins added to aspirin therapy
      • mark k chelmowski
      Ann Intern Med published online October 26, 2009

    Summary for Patients

    • Summaries for Patients:The Cost-Effectiveness of Aspirin, Statins, or Both Drugs in the Primary Prevention of Heart Disease Ann Intern Med March 7, 2006 144:I-29
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