Aspirin for coronary heart prevention is less costly, more effective

Using aspirin for coronary heart prevention is less costly and more effective than doing nothing in men older than 45 with more than 10 percent 10-year-risk of the disease, according to a study by researchers at RTI International, University of Michigan, and University of North Carolina at Chapel Hill.

The study, published online in the Archives of Internal Medicine, used a Markov model to compare the costs and outcomes of prescribing low-dose aspirin alone, aspirin plus a proton-pump inhibitor, or no treatment for coronary heart prevention. The researchers specifically considered the effects of each treatment on cardiovascular events and risk of upper gastrointestinal bleeding.

"This analysis supports the role of aspirin for primary prevention of cardio heart disease events in middle-aged men across a range of cardio heart disease and gastrointestinal bleeding risk levels," said Stephanie Earnshaw, Ph.D., a health economist at RTI Health Solutions, a business unit of RTI, and the paper's lead author.

"Increased risk of gastrointestinal bleeding does not reduce aspirin's net benefit until gastrointestinal bleeding risk becomes quite high."

The researchers also found that adding proton pump inhibitors was not cost-effective for men with average gastrointestinal tract bleeding, but may be cost-effective for selected men at increased risk for gastrointestinal bleeding.