Aspirin and statin medications (used to treat high cholesterol) both prevent heart disease in men at risk. The use of these therapies together has not been evaluated, and a comparison of their efficacy and cost-effectiveness would help physicians to counsel their patients to take one or both. They conclude that many men who are middle age or older should be advised to take aspirin because it produces overall benefits and saves money. Statins, while beneficial, should be recommended for a narrower set of men who are older or at greater risk.
The authors of this article used a computer model to help evaluate the potential benefits and harms of using these medications individually or together. One rationale is to identify the subpopulations where one or both of these medications provide a large enough overall benefit in relationship to cost.
The computer model evaluated a hypothetical population of 45-year-old men, who had an estimated 10-year risk of 7.5% of having a heart attack. They compared the benefits and harms of treating these men with aspirin, a statin medication, or both, compared with no treatment. The benefits and harms were evaluated using quality-adjusted life years (QALYs), a standard tool to compare and contrast the burden of different diseases. QALYs account for a therapy’s ability to save lives and reduce disability in those living. By examining cost, the study allowed the therapies to be compared in terms of how much benefit could be achieved per dollar expended. In favorable situations, there is even a potential to produce benefit and save money.
In the hypothetical population of 45-year-old men, with an estimated 10-year risk of heart attack of 7.5%, the benefits of aspirin outweighed the harms – that is, the QALY’s gained by reduced risk of heart disease outweighed the QALY’s lost by the increased risk of gastrointestinal bleeding and hemorrhagic (bleeding) stroke.
In this population, aspirin not only improved QALYs, but also saved costs, indicating that aspirin is both efficacious and cost-saving.
The addition of statin therapy led to even greater benefits, but it did so at significant cost – around $56,000 for each QALY gained.
If the hypothetical population of 45-year-old men had a higher risk of heart disease at the start (10% instead of 7.5%), the addition of a statin appeared to be more cost-effective, at 42,000 dollars per QALY gained.
The most cost effective treatment for the prevention of heart disease is aspirin alone in a hypothetical population of 45-year-old men at moderate risk of future heart attacks. In this population, the benefits of aspirin outweighed the risks and would save money. Addition of a statin to aspirin, also produced benefits, but generated additional health care costs.
Statins should be used in addition to aspirin for men 45 years of age or older at greater than moderate risk of heart disease.