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Cost-Effectiveness of Aspirin Adherence for Secondary Prevention of Cardiovascular Events

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  • Laurence M. Djatche

    (Thomas Jefferson University)

  • Stefan Varga

    (Thomas Jefferson University)

  • Robert D. Lieberthal

    (The University of Tennessee, Knoxville)

Abstract

Background Suboptimal adherence to aspirin therapy for secondary prevention of cardiovascular (CV) events is an important public health problem. Prior studies have demonstrated non-adherent patients are at higher risk of experiencing CV events. Objectives This study aimed to estimate the clinical and economic outcomes of aspirin non-adherence in patients with a prior primary CV event. Methods We developed a Markov model to estimate the cost-effectiveness of aspirin adherence from a generic US managed care payer perspective over a 5-year time horizon. Costs, utilities and rates of aspirin adherence, CV events and adverse events were gathered from published literature to populate the model. Outcomes were quality-adjusted life years (QALYs), costs (US$) and incremental cost-effectiveness ratios (ICERs). We applied the model separately to a population without type II diabetes as a comorbidity (non-diabetic model) and a population with type II diabetes (type II diabetes model). A one-way sensitivity analysis was performed to assess the model uncertainty. Results The base case showed adherent patients lived 0.25 and 0.36 QALYs longer than non-adherent patients in the non-diabetic model and type II diabetes model, respectively. Adherence to aspirin had an ICER of US$25/QALY in the non-diabetic population, while it saved US$297 per patient over a 5-year period in the type II diabetes population. One-way sensitivity analysis showed the models were most sensitive to rates of non-fatal events in non-adherent patients. Conclusion This study suggests aspirin adherence may improve QALYs for patients with a prior primary CV event. Further, it may decrease costs in patients with type II diabetes. While additional research is needed to validate these results, payers may wish to increase strategies to promote adherence in order to improve population health. Trial Registration Not applicable.

Suggested Citation

  • Laurence M. Djatche & Stefan Varga & Robert D. Lieberthal, 2018. "Cost-Effectiveness of Aspirin Adherence for Secondary Prevention of Cardiovascular Events," PharmacoEconomics - Open, Springer, vol. 2(4), pages 371-380, December.
    • Handle: RePEc:spr:pharmo:v:2:y:2018:i:4:d:10.1007_s41669-018-0075-2
    DOI: 10.1007/s41669-018-0075-2
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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    1. Fernando Alarid-Escudero & Eline M. Krijkamp & Eva A. Enns & Alan Yang & M. G. Myriam Hunink & Petros Pechlivanoglou & Hawre Jalal, 2021. "A Tutorial on Time-Dependent Cohort State-Transition Models in R using a Cost-Effectiveness Analysis Example," Papers 2108.13552, arXiv.org, revised Jun 2022.

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