Aspirin, statins, or both drugs for the primary prevention of coronary heart disease events in men: a cost-utility analysis.

BACKGROUND Aspirin and statins are both effective for primary prevention of coronary heart disease (CHD), but their combined use has not been well studied. OBJECTIVE To perform a cost-utility analysis of the effects of aspirin therapy, statin therapy, combination therapy with both drugs, and no pharmacotherapy for the primary prevention of CHD events in men. DESIGN Markov model. DATA SOURCES Published literature. TARGET POPULATION Middle-aged men without a history of cardiovascular disease at 6 levels of 10-year risk for CHD (2.5%, 5%, 7.5%, 10%, 15%, and 25%). TIME HORIZON Lifetime. PERSPECTIVE Third-party payer. INTERVENTIONS Low-dose aspirin, a statin, both drugs as combination therapy, or no therapy. OUTCOME MEASURE Cost per quality-adjusted life-year gained. RESULTS OF BASE-CASE ANALYSIS For 45-year-old men who do not smoke, are not hypertensive, and have a 10-year risk for CHD of 7.5%, aspirin was more effective and less costly than no treatment. The addition of a statin to aspirin therapy produced an incremental cost-utility ratio of 56,200 dollars per quality-adjusted life-year gained compared with aspirin alone. RESULTS OF SENSITIVITY ANALYSIS Excess risk for hemorrhagic stroke and gastrointestinal bleeding with aspirin, risk for CHD, the cost of statins, and the disutility of taking medication had important effects on the cost-utility ratios. LIMITATIONS Several input parameters, particularly adverse event rates and utility values, are supported by limited empirical data. Results are applicable to middle-aged men only. CONCLUSIONS Compared with no treatment, aspirin is less costly and more effective for preventing CHD events in middle-aged men whose 10-year risk for CHD is 7.5% or higher. The addition of a statin to aspirin therapy becomes more cost-effective when the patient's 10-year CHD risk before treatment is higher than 10%.