Details

Autor(en) / Beteiligte

• Pignone, Michael
• Earnshaw, Stephanie
• Tice, Jeffrey A
• Pletcher, Mark J

Titel

Aspirin, statins, or both drugs for the primary prevention of coronary heart disease events in men: a cost-utility analysis

Ist Teil von

• Annals of internal medicine, 2006-03, Vol.144 (5), p.326

Ort / Verlag

United States

Erscheinungsjahr

2006

Quelle

MEDLINE

Beschreibungen/Notizen

• Aspirin and statins are both effective for primary prevention of coronary heart disease (CHD), but their combined use has not been well studied. 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. Markov model. Published literature. 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%). Lifetime. Third-party payer. Low-dose aspirin, a statin, both drugs as combination therapy, or no therapy. Cost per quality-adjusted life-year gained. 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 dollars per quality-adjusted life-year gained compared with aspirin alone. 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. Several input parameters, particularly adverse event rates and utility values, are supported by limited empirical data. Results are applicable to middle-aged men only. 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%.