Potential economic impact of increasing low dose aspirin usage on CVD in the US

Abstract

Background:

Cardiovascular disease (CVD) is a leading cause of death in the US and Western Europe, but regular use of preventive low-dose aspirin has proven effective in preventing CVD events. The purpose of this study was to explore the potential economic impact in the US if preventive aspirin usage were to be increased in line with clinical guidelines for primary and secondary prevention.

Methods:

The risk profile of the US population was characterized using NHANES data, and Framingham cardiovascular risk equations were applied to calculate risk for myocardial infarction, angina and ischemic stroke according to age and gender. Primary and secondary patients were considered separately. Using publicly available unit costs, a budget impact model calculated the annual impact of increased preventive aspirin usage considering gastrointestinal bleeding and hemorrhagic stroke adverse events and diminishing aspirin adherence over a 10-year time horizon.

Results:

In a base population of 1,000,000 patients, full implementation of clinical guidelines would potentially prevent an additional 1273 myocardial infarctions, 2184 angina episodes and 565 ischemic strokes in primary prevention patients and an additional 578 myocardial infarctions, and 607 ischemic strokes in secondary prevention patients. This represents a total savings of $79.6 million for primary prevention and $32.2 million for secondary and additional out-of-pocket expense to patients of $29.0 million for primary prevention and $2.6 million for secondary prevention for the cost of aspirin.

Conclusions:

This budgetary model suggests that there is a strong economic case, both for payers and society, to encourage aspirin use for patients at appropriate risk and per clinical guidelines. It also provides an example of how minimizing costs do not necessarily have to imply a rationing of care. Limitations include the exclusion of other CVD interventions in the analysis.

Key words:

• Budget impact model
• Cardiovascular disease
• Stroke prevention

Transparency

Declaration of funding

Bayer Schering Pharma conceived and funded this research; technical work was carried out by United BioSource Corporation (UBC).

Declaration of financial/other relationships

K.W.J. has disclosed that she reviewed the model as an active collaborator. In order to avoid any potential for bias this might cause, care was made to consistently select conservative values throughout the model. S.M., A.B. and F.P. have disclosed that they are employed by UBC, which provides consulting and other research services to pharmaceutical, device, government and non-government organizations. In this salaried position, S.M., A.B. and F.P. work with a variety of companies and organizations. They receive no payment or honoraria directly from these organizations for services rendered. A.M.F. has disclosed that he has received research support from Bayer and is a consultant to Bayer. The manuscript was developed entirely by the authors.

Acknowledgements

The authors thank Prof. Sean Sullivan for his role in reviewing the model.