THE COST-EFFECTIVENESS OF A MEDIA CAMPAIGN TO INCREASE ASPIRIN USE FOR PRIMARY PREVENTION OF CARDIOVASCULAR EVENTS

The Cost-Effectiveness of a Media Campaign to Increase Aspirin Use for Primary Prevention of Cardiovascular Events

Purpose:

   Low-dose aspirin is recommended by the U.S. Preventive Services Task Force (USPSTF) for the primary prevention of cardiovascular events. A media campaign may increase the use of aspirin. However, it is unclear if the costs resulting from this campaign can offset the clinical benefits. We estimated the cost-effectiveness of a media campaign to promote aspirin use in Minnesota.

Method:  

   We developed a Markov decision model (Figure 1) based on 2011 Minnesota Hospital Association data which provided the incidence of cardiovascular disease (CVD) events and published estimates from the literature. The model compares the cost per quality-adjusted life-year (QALY) gained from the aspirin campaign for primary prevention with no campaign. We set the annual discount rate at 3% for both costs and utilities, used a time horizon of 10 years due to the request from the campaign authority and analyzed from the payer's perspective. Our base case scenario considered a target population which consists of 40% 45-year-old men and 60% 55-year-old women with time-dependent CVD rates, respectively. For the sensitivity analyses, we modified assumptions regarding aspirin use rates, CVD event rates and the time horizon. The media campaign effect was assumed to be persistent in those scenarios.

 Result:  

   The preliminary results show that the 3-year long campaign was less effective and more costly than no campaign over a 10-year period. This reflects the high cost of adverse events related to GI bleeding relative to averted AMI and stroke events in the window. In contrast, the campaign strategy becomes effective when the target population reaches 65 years of age for men and 70 years old for women. Moreover, the campaign is cost-effective with an ICER of $778 per QALY by 79 years of age, which is the upper age limit for use of aspirin as primary prevention.

Conclusion:  

   The clinical benefits from the campaign are not cost-effective in the short run due to higher GI bleeding rates at earlier ages.  As incidence of CVD events increase with age, the benefits from the campaign rise as well, suggesting that such a campaign may be of particular value to Medicare.