ASA + Estatinas son solo costo-efectivas en alto riesgo cardiovascular


ASA + statins only cost-effective at high risk

Clinical Question:<!–
D([“mb”,”\u003c/h3\u003e\n\u003cp\u003e\n In men without a history of cardiovascular disease, is low-dose aspirin, a statin, or both drugs \ncost-effective in preventing cardiovascular events?\n\u003c/p\u003e\n\n\u003ch3\u003eBottom Line:\u003c/h3\u003e\n\u003cp\u003e\n From the viewpoint of cost to a third-party payer, the costs of aspirin alone are reasonable in \nmen at low-risk for coronary heart disease (CHD); the addition of a statin to aspirin therapy in \nthese men is above what is considered to be reasonable cost for prevention. However, the \ncombination of aspirin and a statin is cost-effective when men are at high risk (10% or above). \u003ca href\u003d\”http://www.infopoems.com/levels.html\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\u003e(LOE \u003d 2a)\u003c/a\u003e\n\u003c/p\u003e\n\n\u003ch3\u003eReference:\u003c/h3\u003e\n\u003cp\u003e\n \u003ca href\u003d\”http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd\u003dRetrieve\u0026amp;db\u003dPubMed\u0026amp;list_uids\u003d16520473\u0026amp;dopt\u003dAbstract\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\u003ePignone \nM, Earnshaw S, Tice JA, Pletcher MJ. Aspirin, statins, or both drugs for the primary prevention of \ncoronary heart disease events in men: A cost-utility analysis. Ann Intern Med 2006;144:326-36.\u003c/a\u003e\n\u003c/p\u003e\n\n\u003cdiv\u003e\n\u003ch3\u003eStudy Design:\u003c/h3\u003e\n\u003cp\u003e\n Cost-effectiveness analysis\n\u003c/p\u003e\n\u003c/div\u003e\n\n\n\u003cdiv\u003e\n\u003ch3\u003eFunding:\u003c/h3\u003e\n\u003cp\u003e\n Industry + govt\n\u003c/p\u003e\n\u003c/div\u003e\n\n\n\u003cdiv\u003e\n\u003ch3\u003eSetting:\u003c/h3\u003e\n\u003cp\u003e\n Outpatient (any)\n\u003c/p\u003e\n\u003c/div\u003e\n\n\n\u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eSynopsis:\u003c/h3\u003e\n\u003cp\u003e\n Although both aspirin and statin drugs, separately, are effective for preventing a first CHD \nevent, there is no direct evidence that the combination is more effective than either alone. The \nresearchers conducting this analysis determined the cost-effectiveness of the combination from the \nperspective of a third-party payer and we can use this analysis to understand the relative benefits \nof the 2 treatments. The researchers started with a base-case scenario of a 45-year-old man with a \n10-year risk of CHD of 7.5% treated with aspirin, statin therapy, both, or neither for 10 years. \nThe outcome was the development of a CHD event — stroke, myocardial infarction, or death — over \nthe 10 years. The Markov model used in this analysis also assumed that all patients would be \ntreated with both drugs after 10 years and then estimated their life-time cost-utility ratio. They \nalso considered the major risks of treatment, gastrointestinal bleeding, and myopathy-related \ndeath, derived from results of clinical trials. “,1]
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In men without a history of cardiovascular disease, is low-dose aspirin, a statin, or both drugs cost-effective in preventing cardiovascular events?

Bottom Line:

From the viewpoint of cost to a third-party payer, the costs of aspirin alone are reasonable in men at low-risk for coronary heart disease (CHD); the addition of a statin to aspirin therapy in these men is above what is considered to be reasonable cost for prevention. However, the combination of aspirin and a statin is cost-effective when men are at high risk (10% or above). (LOE = 2a)

Reference:

Pignone M, Earnshaw S, Tice JA, Pletcher MJ. Aspirin, statins, or both drugs for the primary prevention of coronary heart disease events in men: A cost-utility analysis. Ann Intern Med 2006;144:326-36.

Study Design:

Cost-effectiveness analysis

Funding:

Industry + govt

Setting:

Outpatient (any)

Synopsis:

Although both aspirin and statin drugs, separately, are effective for preventing a first CHD event, there is no direct evidence that the combination is more effective than either alone. The researchers conducting this analysis determined the cost-effectiveness of the combination from the perspective of a third-party payer and we can use this analysis to understand the relative benefits of the 2 treatments. The researchers started with a base-case scenario of a 45-year-old man with a 10-year risk of CHD of 7.5% treated with aspirin, statin therapy, both, or neither for 10 years. The outcome was the development of a CHD event — stroke, myocardial infarction, or death — over the 10 years. The Markov model used in this analysis also assumed that all patients would be treated with both drugs after 10 years and then estimated their life-time cost-utility ratio. They also considered the major risks of treatment, gastrointestinal bleeding, and myopathy-related death, derived from results of clinical trials. <!–
D([“mb”,”\u003cbr\u003e\n\u003cbr\u003e\nFor men at low risk, lifetime aspirin therapy increases their lifespan an average of 3 days \n(adjusted for quality of those days, or \u0026quot;quality-adjusted days\u0026quot;). Men at moderate (7.5%) risk \ngained an average 17 quality-adjusted days, and men at moderate to high risk (10%) gained 24 \nquality-adjusted days. When statin was theoretically added to aspirin treatment, the average \nincrease in lifespan was 13 days for low-risk men (an additional 10 days over aspirin alone), 35 \ndays for moderate risk (an additional 18 days), and 45 days (an additional 21 days) for men at \nmoderate to high risk. In men with low risk, the cost per quality-adjusted life-year is a very \nreasonable $9800 US for aspirin alone but $164,700 US for the combination. At moderate risk, \ncombination therapy is a reasonable $56,200 (though the range, depending on the sensitivity \nanalysis, was $26,100 to $246,276). At moderate to high risk the cost per quality-adjusted \nlife-year was $42,500 (range \u003d $20,600 – $188,000).\n\u003c/p\u003e\n\n\u003cp\u003e\n Copyright © 2006 by \u003ca href\u003d\”http://www.wiley.com/go/copyright\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\u003eWiley Subscription \nServices\u003c/a\u003e, Inc. All rights reserved.\n\u003c/p\u003e\n\n\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\n \u003cdiv\u003e\n \u003cp\u003e\n \u003ca href\u003d\”http://www.infopoems.com\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\u003ewww.InfoPOEMs.com\u003c/a\u003e\n \u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e\n This is an automated email. Replies will be ignored.\u003cbr\u003e\n \u003ca href\u003d\”http://www.infopoems.com/support/dpOptions.cfm\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\u003eUnsubscribe or Manage your Daily InfoPOEMs delivery options\u003c/a\u003e from the InfoPOEMs Website.\n \u003cbr\u003e\n Copyright © 2006 by \u003ca href\u003d\”http://www.wiley.com/go/copyright\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\u003eWiley Subscription Services\u003c/a\u003e, Inc. All rights reserved. \u003ca href\u003d\”http://www.infopoems.com\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\u003e”,1]
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For men at low risk, lifetime aspirin therapy increases their lifespan an average of 3 days (adjusted for quality of those days, or “quality-adjusted days”). Men at moderate (7.5%) risk gained an average 17 quality-adjusted days, and men at moderate to high risk (10%) gained 24 quality-adjusted days. When statin was theoretically added to aspirin treatment, the average increase in lifespan was 13 days for low-risk men (an additional 10 days over aspirin alone), 35 days for moderate risk (an additional 18 days), and 45 days (an additional 21 days) for men at moderate to high risk. In men with low risk, the cost per quality-adjusted life-year is a very reasonable $9800 US for aspirin alone but $164,700 US for the combination. At moderate risk, combination therapy is a reasonable $56,200 (though the range, depending on the sensitivity analysis, was $26,100 to $246,276). At moderate to high risk the cost per quality-adjusted life-year was $42,500 (range = $20,600 – $188,000).