Aspirin in the primary prevention of cardiovascular disease in hypertensive patients - the health economic perspective

Abstract

Low-dose aspirin is standard care in patients with a history of cardiovascular disease (CVD). In primary prevention it is more controversial although recent meta-analyses and US and European guidelines support its use in persons at increased CVD risk, for example persons with hypertension. This study aims to evaluate the total costs and cost-effectiveness of low-dose aspirin in hypertensive patients. A state-transition model was developed to compare the total cost of low-dose aspirin with placebo in the primary prevention of CVD over 10 years. Three populations were studied: new hypertensive patients (Group 1), treated hypertensive patients with blood pressure (BP) < 160/95 mm/Hg (Group 2), treated hypertensive patients with BP ≥ 160/95 mmHg (Group 3). Ten year cumulative risk of CVD in the studied patients groups was provided by the PRCOCAM-investigators. Risk reduction with low-dose aspirin was based on two recent meta-analyses. Direct costs from the perspective of the German healthcare system (GKV), i.e. excluding patient co-payment, were used (base year 2003). Outcomes are expressed as difference in 10-year total costs () and gains in quality-adjusted life years (QALY). As shown in the following table administering low-dose aspirin is cost saving and leads to gains in quality-adjusted life years in the 3 populations studied, with the largest savings found in the highest risk group. Sensitivity analyses proved robustness of the results. Difference in total costs and gains in quality-adjusted life years over 10 years Difference in total costs and gains in quality-adjusted life years over 10 years We conclude that administering low-dose aspirin to patients with newly diagnosed hypertension, a BP treated to values < 160/95 mmHg and BP treated to ≥ 160/95 mmHg is significantly cost-saving from the GKV perspective. Both on clinical and economic grounds, primary prevention with low-dose aspirin seems recommendable in hypertensive patients.