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If aspirin is indeed effective for reducing cancer mortality, many middle-aged men at low cardiovascular risk would become candidates for regular aspirin use, based on an updated
Markov model that estimated events, costs, life-years, and quality-adjusted life years (QALYs).
The base case scenario simulated men with a starting age of 45 years; no history of coronary heart disease (CHD) events, diabetes, or stroke; and a 5% 10-year CHD risk. Costs and life-years for men taking aspirin for 10 years were compared with men who were not taking aspirin over those 10 years; after 10 years, the treatments were equalized and the cohort was followed until death. The main outcome was cost per quality-adjusted life year (QALY) gained for aspirin vs no therapy. Cost per QALY was estimated first assuming no effect of aspirin on cancer mortality, then again assuming a 22% relative reduction in cancer mortality.
When no effect of aspirin on cancer mortality was assumed, aspirin had a cost per QALY gained of $22,492 at 5% 10-year CHD risk; at 2.5% risk or less, aspirin use was more costly than no treatment. When the reduction in cancer mortality was included, aspirin became cost-effective for men at 2.5% risk (cost per QALY, $43,342). Aspirin remained cost-saving or cost-effective (<$50,000 per QALY) in probabilistic analyses for men at 5% risk (59% with no cancer effect included; 96% with cancer effect).
J Gen Intern Med. 2013 May 17. [Epub ahead of print]