By Christian Duffin
Treatment with aspirin for coronary heart disease prevention is less costly and more effective than no treatment in men older than 45 years with a greater than 10% 10-year risk of disease, a US study shows.
Researchers used a Markov model to compare the costs and outcomes of prescribing low-dose aspirin alone, aspirin plus a proton-pump inhibitor, or no treatment, for CHD prevention.
In 45-year-old men with a 10-year CHD risk of 10%, and an annual bleeding risk of eight bleeds in 10,000, aspirin was less costly and more effective, at $17,571 and 18.7 quality-adjusted life-years (QALYs) gained compared with no treatment, which cost $18 483 and had a 18.4 QALY gain.
Compared with aspirin alone, aspirin plus a PPI had a high incremental cost per QALY. Results were similar in 55- and 65-year old men.
Dr Stephanie Earnshaw, a health economist at RTI health solutions in North Carolina, concluded: ‘Increased risk of GI bleeding does not reduce aspirin's net benefit until GI bleeding risk becomes quite high.
‘Adding PPI therapy does not appear to be cost-effective for those patients at low or average risk for GI bleeding but may be valuable for those with a GI bleeding risk over 4 per 1000 per year.'