For older Americans with high risk for CVD, daily use of low-dose aspirin could result in reduced MI risk, prevention of cancer onset and cancer death, and savings of $692 billion in health care costs over 20 years, according to an analysis.
“Although the health benefits of aspirin are well established, few people take it,” David B. Agus, MD, professor of medicine and engineering at the University of Southern California and founding director and CEO of the Lawrence J. Ellison Institute for Transformative Medicine at USC, said in a press release. “Our study shows multiple health benefits and a reduction in health care spending from this simple, low-cost measure that should be considered a standard part of care for the appropriate patient.”
Primary prevention controversy
The U.S. Preventative Services Task Force (USPSTF) in April recommended low-dose aspirin for primary prevention of CVD and colorectal cancer, but the FDA has not allowed aspirin to be marketed as a therapy for primary prevention of CVD, citing concerns about bleeding risk.
Agus and colleagues used the Future Elderly Model, a dynamic microstimulation following U.S. individuals aged 50 years and older, to project lifetime health and health spending based on current aspirin use and based on several scenarios of expanded aspirin use.
The model is mainly based on data from the Health and Retirement Study, a national survey ongoing for more than 2 decades, the researchers wrote.
The outcomes of interest were CHD, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy and medical costs.
Agus and colleagues determined that more than 40% of American men and more than 10% of American women aged 50 to 79 years at high CV risk are not taking daily aspirin.
If a “guideline adherence” scenario, in which all eligible individuals based on the USPSTF and American Heart Association guidelines took daily aspirin and experienced its accompanying benefits and adverse events, were followed, cumulative incidence of CVD by age 79 years would be reduced from 487 per 1,000 people to 476 per 1,000 people (difference, –11; 95% CI, –23 to –2).
There would not be significant reductions in stroke because increased risk for hemorrhagic stroke offsets decreased risk for ischemic stroke, or in incident cancer, because initial cancer prevention would be offset by cancers developed by people with extended life, they wrote. In the guideline adherence scenario, gastrointestinal bleeds would rise 25% compared with the status quo, translating to an additional one in 63 individuals aged 51 to 79 years having one.
Life expectancy gains
The model also projected that in the guideline adherence scenario, of 1,000 Americans, eight more would reach age 80 years and three more would reach age 100 years compared with the status quo, for a gain of 0.28 years of life expectancy (95% CI, 0.08-0.5), one-third of which would be without disability, and for an increase in expected quality-adjusted left expectancy of approximately 0.2 years.
Those who would most benefit are younger men at high risk for CHD and younger women at high risk for stroke, according to the researchers.
The guideline adherence scenario would add 900,000 people (95% CI, 300,000-1.4 million) to the U.S. population by 2036, which, after valuation of quality-adjusted life-years, translates to $692 billion (95% CI, 345 billion-975 billion) in net health benefits during the next 20 years, Agus and colleagues wrote.
“The irony of our findings is that aspirin may be too cheap,” Dana Goldman, PhD, director of the Schaeffer Center for Health Policy and Economics and distinguished professor of public policy, pharmacy and economics at USC, said in the release. “Only 40% of Americans are taking aspirin when they should, and providers have little incentive to push that up, despite the obvious benefits and health care savings. Until we figure out how to reward providers and manufacturers for long-term outcomes, no one is going to do anything about this problem.” – by Erik Swain
One researcher reports being employed by Analysis Group Inc.