Key result
Administering low-dose aspirin to patients with a 1-year CHD risk of 1.5% saved an average of JPY 116,000 per patient over 10 years compared to no aspirin.
Why the study?
Does low-dose aspirin improve cost-effectiveness and life-years gained in patients with a 1-year risk of CHD of 1.5%?
Does low-dose aspirin improve cost-effectiveness and life-years gained in patients with a 1-year risk of CHD of 1.5%?
Effect estimate: Savings of JPY 116,000 (95% CI 57,077-175,151)
Absolute Event Rate: 518000% vs 634000%
Administering low-dose aspirin for primary prevention in patients with a 1-year CHD risk of ≥1.5% is significantly cost-saving from the insurers' perspective in Japan.
Supports modeled cost savings for aspirin at 1.5% CHD risk in Japan; leaves open real-world net benefit and generalizability.
OBJECTIVE: Low-dose aspirin is standard care in patients with a history of cardiovascular disease (CVD). But, the use of low-dose aspirin in primary prevention has not yet been fully established in Japan although meta-analyses and US/European guidelines support its use in persons at increased CVD risk. This study assessed the health economic consequences of the use of low-dose aspirin in the primary prevention of CVD in Japan. PATIENTS AND METHODS: Based on results reported in two recent meta-analyses of Hayden (2002) and Eidelman (2003), a Markov model was constructed to predict the cost-effectiveness of low-dose aspirin in the primary prevention of CVD. The model consists of 5 health states: 1) no history of CVD, 2) history of stroke, 3) history of myocardial infarction, 4) history of CVD, and 5) death, with a 10-year time horizon and 1-year cycles. Direct costs from the insurers' perspective were used, while health outcome was expressed in Life-Years Gained (LYG). 'Discounting Rate' with 3% was applied on effectiveness and costs. RESULTS: For patients with a 1-year risk of coronary heart disease (CHD) of 1.5% (10-year risk of +/-15%), the model demonstrated 'dominance' of the 'aspirin' arm versus 'no aspirin' arm; the 10-year costs were Japanese Yen (JPY) 634,000 (Euro 4,857) and JPY 518,000 (Euro 3,968) in the 'no aspirin' arm and 'aspirin' arm, respectively, while LYG was 8.33 and 8.36, respectively. Low-dose aspirin treatment saved on average JPY 116,000 (Euro 889) [95% confidence interval (CI) JPY 57,077-175,151] per patient. Dominance was demonstrated (non-significant) in the first year of treatment and, low-dose aspirin was dominant to 'no aspirin' arm from an annual risk of 0.20%. Other results of sensitivity analysis on gastrointestinal (GI) bleeding rate, stroke rate, cost of each event and discounting showed the robustness of the results. CONCLUSIONS: Administering low-dose aspirin to patients with a 1-year risk of CHD of 1.5% and more is significantly cost-saving from the insurers' perspective in Japan.
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Tsutani et al. (2007) studied Primary prevention of cardiovascular disease. Low-dose aspirin vs. No aspirin was evaluated on 10-year costs per patient (JPY) (Savings of JPY 116,000, 95% CI 57,077-175,151). Administering low-dose aspirin to patients with a 1-year CHD risk of 1.5% saved an average of JPY 116,000 per patient over 10 years compared to no aspirin.
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