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

Overview

In this article, the authors incorporate the additional preventive benefits of aspirin for reducing colon cancer deaths into a statistical model to help determine whether inclusion of this outcome expands the number of people likely to receive benefits that outweigh harms. Accounting for both cardiovascular and cancer prevention benefits, aspirin was cost-effective for middle aged men with a 10 year chance of developing cardiovascular disease as low as 2.5% (half the rate compared to not accounting for cancer benefits). This expanded the population where aspirin benefits exceeded harms. This analysis suggests that aspirin recommendations should not be based solely on cardiovascular disease, as in current federal guidelines, but rather should incorporate cancer prevention.

Methodology

The investigators focused on a hypothetical population of men without diabetes or heart disease who were given aspirin therapy. They estimated the decreased risk of cardiovascular disease and cancer in this population compared with the increased risk of GI bleeding and stroke. Their model incorporated quality-adjusted life years (QALYs, a measure of the relative quality of life that adjusts for less quality following health events like heart attacks) and 2012 U.S. dollars as the units of disease burden and cost. The authors estimated the cost in dollars per each QALY gained by taking aspirin compared to not taking it.

Results

  • Accounting for both cardiovascular and cancer prevention benefits, aspirin is cost-effective for middle aged men whose 10-year risk of developing cardiovascular disease is greater than 2.5%.

  • Without accounting for cancer benefits, cost-effective use of aspirin would require a cardiovascular risk of greater than 5% over 10 years.

Conclusions

  • Cancer reduction is a benefit of aspirin therapy in addition to cardiovascular disease reduction. Taking into account cancer reduction in selecting patients eligible for aspirin would significantly increase the number of patients where aspirin is recommended.

  • Aspirin has risks, including gastrointestinal bleeding and hemorrhagic (bleeding) strokes. In this population, however, harms are outweighed by benefits, including fewer heart attacks and reduced treatment costs.

  • Aspirin recommendation should not be based solely on cardiovascular disease, as is currently the case with federal guidelines. Instead, patients and physicians discussing aspirin use should also account for the known cancer prevention. By incorporating cancer reduction into the model, the number of patients who would benefit from aspirin use increased significantly.