Cost-effectiveness Of Aspirin Research Articles

Venous Thromboembolism Prophylaxis after Total Knee Arthroplasty.

Venous thromboembolic disease (VTED) is a major cause of morbidity and mortality after total knee arthroplasty (TKA). Current VTED prophylaxis protocols consist of early mobilization, mechanical compression devices, and pharmacologic agents. Venous phasic flow-regulated below-knee devices are generally favored, but the optimal duration and method of mechanical prophylaxis is unknown. Risk stratification models have been developed to guide pharmacologic prophylaxis. For patients with standard VTED risk profile, aspirin has become increasingly popular. Recent studies have validated the efficacy, relatively low bleeding risks, and cost-effectiveness of aspirin in the patients with standard risk profile. Current evidence suggests that the newer oral anticoagulants, including the factor Xa and the direct thrombin inhibitors, are effective for the reduction of postoperative VTED but may be associated with increased bleeding and wound complication rates.

PTH-188 Is it more cost-effective to treat patients with non-dysplastic barrett’s oesophagus with aspirin and statins rather than to undertake endoscopic surveillance?: Abstract PTH-188 Table 1

Introduction Endoscopic surveillance and therapy with endoscopic mucosal resection and radio-frequency ablation have an established role in dysplasia in Barrett’s oesophagus (BO). However, the most cost-effective strategy in non-dysplastic BO remains uncertain. Aspirin and Statins are associated with a reduced risk of oesophageal adenocarcinoma. We have examined the cost-effectiveness of Aspirin and Statins without endoscopic surveillance in non-dysplastic BO in comparison with other potential strategies. Method A Markov model was created using a base population of 1,000 50-year old Caucasian males with non-dysplastic BO followed to 75 years of age. All subjects were assumed fit for oesophagectomy. Subjects on Aspirin and Statin therapy did not undergo surveillance and this cohort was compared with subjects undergoing endoscopic surveillance at 1, 2, 3, 4 and 5-yearly intervals with endoscopic therapy used to treat dysplasia. These cohorts were referenced to a base population who did not undergo surveillance and in whom the natural history was modelled. Cost-effectiveness was expressed as net amount per quality adjusted life year (QALY) and base-costs for treatment were obtained from the Department of Health HRG tariffs for 2014. Monte Carlo simulation and probabilistic sensitivity analysis were carried out. Results The most cost-effective strategy was 2-yearly surveillance of non-dysplastic BO with an average cost per subject of £5184, yielding 14.69 QALY and an ICER of 21763. Aspirin and Statin therapy without surveillance resulted in a cost of £1735 per subject and 14.23 QALY and was more cost-effective than no surveillance, due to an overall reduction in the incidence of dysplasia with Aspirin and Statins. However, a strategy of using Aspirin and Statins was not as cost-effective as 2-yearly, 3-yearly or 5-yearly surveillance with endoscopic therapy for dysplasia, due to the cost of palliation of incident advanced cancers in the Aspirin and Statin population (not undergoing surveillance). Conclusion Aspirin and Statin therapy in non-dysplastic BO is more cost-effective than no surveillance but is less cost-effective than endoscopic surveillance and therapy for incident dysplasia. The most cost-effective strategy for all patients for BO remains 2-yearly surveillance. Disclosure of interest None Declared.

Cost-effectiveness of aspirin adjuvant therapy in early stage colorectal cancer in older patients.

Background & AimsRecent observational studies showed that post-operative aspirin use reduces cancer relapse and death in the earliest stages of colorectal cancer. We sought to evaluate the cost-effectiveness of aspirin as an adjuvant therapy in Stage I and II colorectal cancer patients aged 65 years and older.MethodsTwo five-state Markov models were constructed separately for Stage I and II colorectal cancer using TreeAge Pro 2014. Two hypothetical cohorts of 10,000 individuals at a starting age of 65 years and with colorectal cancer in remission were put through the models separately. Cost-effectiveness of aspirin was evaluated against no treatment (Stage I and II) and capecitabine (Stage II) over a 20-year period from the United States societal perspective. Extensive one-way sensitivity analyses and multivariable Probabilistic Sensitivity Analyses (PSA) were performed.ResultsIn the base case analyses, aspirin was cheaper and more effective compared to other comparators in both stages. Sensitivity analyses showed that no treatment and capecitabine (Stage II only) can be cost-effective alternatives if the utility of taking aspirin is below 0.909, aspirin’s annual fatal adverse event probability exceeds 0.57%, aspirin’s relative risk of disease progression is 0.997 or more, or when capecitabine’s relative risk of disease progression is less than 0.228. Probabilistic Sensitivity Analyses (PSA) further showed that aspirin could be cost-effective 50% to 80% of the time when the willingness-to-pay threshold was varied from USD20,000 to USD100,000.ConclusionEven with a modest treatment benefit, aspirin is likely to be cost-effective in Stage I and II colorectal cancer, thus suggesting a potential unique role in secondary prevention in this group of patients.

Statins and Aspirin for Chemoprevention in Barrett's Esophagus: Results of a Cost-Effectiveness Analysis

Data suggest that aspirin, statins, or a combination of the two drugs may lower the progression of Barrett's esophagus to esophageal adenocarcinoma. However, aspirin is associated with potential complications such as gastrointestinal bleeding and hemorrhagic stroke, and statins are associated with myopathy. We developed a simulation disease model to study the effectiveness and cost effectiveness of aspirin and statin chemoprevention against esophageal adenocarcinoma. A decision analytic Markov model was constructed to compare four strategies for Barrett's esophagus management; all regimens included standard endoscopic surveillance regimens: (i) endoscopic surveillance alone, (ii) aspirin therapy, (iii) statin therapy, and (iv) combination therapy of aspirin and statin. Endpoints evaluated were life expectancy, quality-adjusted life years (QALY), costs, and incremental cost-effectiveness ratios (ICER). Sensitivity analysis was performed to determine the impact of model input uncertainty on results. Assuming an annual progression rate of 0.33% per year from Barrett's esophagus to esophageal adenocarcinoma, aspirin therapy was more effective and cost less than (dominated) endoscopic surveillance alone. When combination therapy was compared with aspirin therapy, the ICER was $158,000/QALY, which was above our willingness-to-pay threshold of $100,000/QALY. Statin therapy was dominated by combination therapy. When higher annual cancer progression rates were assumed in the model (0.5% per year), combination therapy was cost-effective compared with aspirin therapy, producing an ICER of $96,000/QALY. In conclusion, aspirin chemoprevention was both more effective and cost less than endoscopic surveillance alone. Combination therapy using both aspirin and statin is expensive but could be cost-effective in patients at higher risk of progression to esophageal adenocarcinoma.

Cost Effectiveness of Aspirin Among Participants with Atherothrombotic Disease in Australian General Practice, Using “Real World” Data from the Australian REACH Registry

Z. Ademi1,∗, D. Liew2, B. Hollingsworth3, P. Steg4, D. Bhatt 5, C. Reid1 1Department of Epidemiology and Preventive Medicine, Monash University, Australia 2 Department of Medicine (St Vincent’s Hospital), University of Melbourne, Australia 3 Centre for Health Economics, Monash University, Australia 4 NSERM U-698, Universite Paris 7 and AP-HP, Paris, France 5 VABostonHealthcare SystemandBrighamandWomen’sHospital, Boston, MA, USA

Aspirin Chemoprevention

In 400 BC, Hippocrates prescribed the bark and leaves of the willow tree, which contain salicin, a natural compound similar to aspirin, to relieve pain and fever.1 In 1948, Dr Lawrence Craven noted that 400 men he prescribed aspirin to had not suffered any heart attacks.1 Forty years later, the Physician’s Health Study was terminated early because of a significant reduction in the incidence of myocardial infarction (MI) among men randomized to 325 mg aspirin every other day compared with placebo.2 Today, aspirin recommendations for chemoprevention of cardiovascular disease (CVD) are incorporated into numerous American Heart Association guidelines (the Table).3–12 The effectiveness of aspirin prophylaxis for patients with CVD has been well established13; however, the clinical utility of aspirin in the primary prevention of CVD has been debated, especially among women.14,15 View this table: Table. AHA Guidelines for the Use of Aspirin in CVD Prevention Article p 2875 In this issue of Circulation , Greving and colleagues,16 using Markov statistical models with simulated Danish cohorts, show that the cost-effectiveness of aspirin in the primary prevention of CVD varies according to gender, age, and baseline level of CVD risk. A threshold of baseline CVD risk >10% in men and >15% in women was shown to be cost-effective. The gender differential has important clinical implications because most women will not attain this level of CVD risk until their later years, and for many women, the risks of aspirin outweighs the benefits in the setting of primary prevention. The authors showed that costs associated with aspirin treatment were greater …

The Cost-Effectiveness of Aspirin, Statins, or Both Drugs in the Primary Prevention of Heart Disease

The Cost-Effectiveness of Aspirin, Statins, or Both Drugs in the Primary Prevention of Heart Disease

Cost-effectiveness of aspirin chemoprevention for Barrett's esophagus.

Recent data suggest that nonsteroidal anti-inflammatory drugs, including aspirin, may prevent the progression of Barrett's esophagus to adenocarcinoma. However, use of aspirin is associated with numerous potential complications, including gastrointestinal bleeding and hemorrhagic strokes. We used a modeling approach to determine and compare the effectiveness and cost-effectiveness of aspirin with and without endoscopic surveillance to prevent esophageal adenocarcinoma. A Markov Monte Carlo decision model was constructed to compare four strategies for management of Barrett's esophagus: aspirin therapy, endoscopic surveillance with biopsies, both, or neither. Patients who took a daily enteric-coated aspirin were modeled to have a 50% reduction in the incidence of esophageal adenocarcinoma but could have complications related to therapy, at which point the aspirin was discontinued. Potential cardiac benefits of aspirin and its role in the chemoprevention of other cancers were not included in the analysis. The analysis was from a societal perspective from age 55 years until death. Sensitivity analyses were performed to investigate the effects of changes in model parameters on estimated costs and effectiveness outcomes across a wide range of assumptions. Aspirin therapy was more effective and less costly than no therapy, resulting in 0.19 more quality-adjusted life years (QALYs). The combination of aspirin and endoscopic surveillance produced 0.27 more QALYs than no therapy at a cost of 13,400 U.S. dollars more, for an associated incremental cost-effectiveness ratio of 49,600 U.S. dollars/QALY. Aspirin use in combination with endoscopic surveillance dominated endoscopic surveillance alone, resulting in 0.06 more QALYs and 11,400 U.S. dollars less cost. The model's results were sensitive to increasing age and to decreased benefit or delay in aspirin's chemopreventive efficacy. Using published values of parameters, regardless of whether a patient undergoes endoscopic surveillance, aspirin use in the management of Barrett's esophagus appears to be a cost-effective strategy to prevent esophageal adenocarcinoma.

Potential cost-effectiveness of aspirin (ASA) chemoprevention against esophageal adenocarcinoma (EAC) and colorectal cancer (CRC) in patients with Barrett's esophagus (BE)

Potential cost-effectiveness of aspirin (ASA) chemoprevention against esophageal adenocarcinoma (EAC) and colorectal cancer (CRC) in patients with Barrett's esophagus (BE)

Cost-Effectiveness of Aspirin and Clopidogrel

Antiplatelet agents have emerged as important therapy for secondary prevention of coronary heart disease (CHD). Evidence shows that, compared with

Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease.

Both aspirin and clopidogrel reduce the rate of cardiovascular events in patients with coronary heart disease. We estimated the cost effectiveness of the increased use of aspirin, clopidogrel, or both for secondary prevention in patients with coronary heart disease. We used the Coronary Heart Disease Policy Model, a computer simulation of the U.S. population, to estimate the incremental cost effectiveness (in dollars per quality-adjusted years of life gained) of four strategies in patients over 35 years of age with coronary disease from 2003 to 2027: aspirin for all eligible patients (i.e., those who were not allergic to or intolerant of aspirin), aspirin for all eligible patients plus clopidogrel for patients who were ineligible for aspirin, clopidogrel for all patients, and the combination of aspirin for all eligible patients plus clopidogrel for all patients. The extension of aspirin therapy from the current levels of use to all eligible patients for 25 years would have an estimated cost-effectiveness ratio of about $11,000 per quality-adjusted year of life gained. The addition of clopidogrel for the 5 percent of patients who are ineligible for aspirin would cost about $31,000 per quality-adjusted year of life gained. Clopidogrel alone in all patients or in routine combination with aspirin had an incremental cost of more than $130,000 per quality-adjusted year of life gained and remained financially unattractive across a wide range of assumptions. However, clopidogrel alone or in combination with aspirin would cost less than $50,000 per quality-adjusted year of life gained if its price were reduced by 70 to 82 percent, to $1.00 and $0.60 per day, respectively. Increased prescription of aspirin for secondary prevention of coronary heart disease is attractive from a cost-effectiveness perspective. Because clopidogrel is more costly, its incremental cost effectiveness is currently unattractive, unless its use is restricted to patients who are ineligible for aspirin.