Which patients should receive aspirin for primary prevention of cardiovascular disease? An economic evaluation

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Preventive Cardiology

Background:

• Low-dose aspirin is standard for secondary cardiovascular disease (CVD) prevention but its primary prevention role is debated.
• Recent guidelines suggest aspirin for primary prevention in at-risk individuals.
• This study evaluates aspirin's cost-effectiveness for primary CVD prevention across European countries.

Purpose of the Study:

• To determine optimal patient selection for primary CVD prevention with low-dose aspirin.
• To analyze the cost-effectiveness of aspirin for primary CVD prevention in diverse European healthcare systems.

Main Methods:

• A state-transition model compared costs and quality-adjusted life-years (QALYs) of aspirin vs. no treatment over 10 years.
• The model utilized data from two meta-analyses and applied it to patients with varying 10-year fatal CVD risks (2-5%) based on the SCORE equation.
• Country-specific direct healthcare costs and discounting were incorporated; Monte Carlo analysis assessed uncertainty.

Main Results:

• Low-dose aspirin was cost-saving and more effective (dominant) for patients with a ≥2% 10-year fatal CVD risk in the UK, Germany, and Spain.
• In Italy, cost-savings began at a 3% risk due to higher gastrointestinal bleeding costs.
• Aspirin was dominant in over 90% of patients with 4-5% 10-year risk across all four countries.

Conclusions:

• Low-dose aspirin is cost-saving for primary CVD prevention even at low 10-year fatal CVD risk thresholds.
• The economic impact of gastrointestinal bleeding is a critical factor in determining aspirin's cost-effectiveness.
• These findings support broader consideration of aspirin for primary CVD prevention based on individual risk stratification.