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

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ABSTRACT

BACKGROUND

Recent data suggest that aspirin may be effective for reducing cancer mortality.

OBJECTIVE

To examine whether including a cancer mortality-reducing effect influences which men would benefit from aspirin for primary prevention.

DESIGN

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.

MAIN MEASURE

Cost per quality-adjusted life year (QALY) gained.

KEY RESULTS

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.

CONCLUSIONS

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.

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Acknowledgements

The authors would like to thank Brenda Denzler and Penny Chumley for their assistance with editing and manuscript formatting.

Funding

Funding for this research was provided by Partnership for Prevention and the National Heart, Lung and Blood Institute (R21 HL112256-01). Dr. Pignone was also supported through an Established Investigator Award from the National Cancer Institute (K05CA129166). Funders had no role in the design of the study, conduct of the study, analysis and interpretation of the data, or preparation and approval of the manuscript.

Conflict of Interest

Dr. Earnshaw and Ms. McDade are employees of RTI Health Solutions, a contract research company that receives funds from pharmaceutical, biotechnology, and medical device/diagnostic manufacturers to perform outcomes research for cardiovascular disease and other conditions.

Author information

Authors and Affiliations

  1. Cecil Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

    Michael Pignone MD

  2. Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Michael Pignone MD

  3. RTI Health Solutions, RTI International Research Triangle Park, RTP, NC, USA

    Stephanie Earnshaw PhD & Cheryl McDade

  4. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    Mark J. Pletcher MD

  5. Department of Medicine, University of North California, 5045 Old Clinic Building UNC Hospital, Chapel Hill, NC, 27599-7110, USA

    Michael Pignone MD

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  1. Michael Pignone MD
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  2. Stephanie Earnshaw PhD
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  4. Mark J. Pletcher MD
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Correspondence to Michael Pignone MD.

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Pignone, M., Earnshaw, S., McDade, C. et al. Effect of Including Cancer Mortality on the Cost-Effectiveness of Aspirin for Primary Prevention in Men. J GEN INTERN MED 28, 1483–1491 (2013). https://doi.org/10.1007/s11606-013-2465-6

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  • DOI: https://doi.org/10.1007/s11606-013-2465-6

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