Cost-Effectiveness of a Statewide Campaign to Promote Aspirin Use for Primary Prevention of Cardiovascular Disease

Abstract

Background: The U.S. Preventive Services Task Force in 2009 recommended increased aspirin use for primary prevention of cardiovascular disease (CVD) in men ages 45 to 79 years and women ages 55 to 79 years for whom benefit outweighs risk. This study estimated the clinical efficacy and cost-effectiveness of a statewide public and health professional awareness campaign to increase regular aspirin use among the target population in Minnesota to reduce first CVD events.

Methods and results: A state-transition Markov model was developed, adopting a payer perspective and lifetime time horizon. The main outcomes of interest were quality-adjusted life years, costs, and the number of CVD events averted among those without a prior CVD history. The model was based on real-world data about campaign effectiveness from representative state-specific aspirin use and event rates, and estimates from the scholarly literature. Implementation of a campaign was predicted to avert 9874 primary myocardial infarctions in men and 1223 primary ischemic strokes in women in the target population. Increased aspirin use was associated with as many as 7222 more major gastrointestinal bleeding episodes. The cost-effectiveness analysis indicated cost-saving results for both the male and female target populations.

Conclusions: Using current U.S. Preventive Services Task Force recommendations, a state public and health professional awareness campaign would likely provide clinical benefit and be economically attractive. With clinician adjudication of individual benefit and risk, mechanisms can be made available that would facilitate achievement of aspirin's beneficial impact on lowering risk of primary CVD events, with minimization of adverse outcomes.

Keywords: aspirin; cardiovascular diseases; cost–effectiveness analysis; epidemiology; myocardial infarction; prevention; stroke.

Figure 1

State‐transition model structure. The hypothetical cohort starts in the well state and can transition to the other states in a model cycle according to corresponding transition probabilities in Table 1. Transition to the death state is allowed from any state. GI indicates gastrointestinal; MI, myocardial infarction.

Figure 2

One‐way sensitivity analysis tornado diagram that summarizes the effect of variation in key model parameters one at a time on the model outcome. The parameters are sorted in descending order by their outcome impact for both (A) males and (B) females, respectively. Longer bars indicate the most important parameters, giving the diagram its “tornado” appearance. The vertical line in both figures represents the base‐case results for both males and females. GI indicates gastrointestinal; QALYs, quality‐adjusted life years; RR, relative risk.

Figure 3

Cost‐effectiveness acceptability curve. The probability that the campaign is cost‐effective (solid line) is greater than that of no campaign (dashed line) at various willingness‐to‐pay thresholds for both males and females. QALYs indicates quality‐adjusted life years.