Aspirin Foundation Meeting 2013
Primary prevention treatment of CHD and CVD
Prof Ceri Phillips - Swansea University, UK
Cost-effectiveness is now an essential component of decision making and commissioning and it’s important for all interventions and all therapies to demonstrate not only that they work but that they actually generate value for money. What I’m going to try and demonstrate today is that the rationale for having aspirin as primary prevention in CHD and CVD wasn’t quite conclusive but now with the additional benefits that aspirin can actually produce in terms of cancer the benefit-cost ratio has changed. The previous work we did showed that the actual cost effectiveness was highly dependent on a number of circumstances and situations such as the cost of actually initiating aspirin as a primary prevention, there’s a cost associated with potential harm and adverse events and the benefits in terms of risk reduction were not really sufficient, perhaps, at least in the extreme cases, to ensure that the strategy would be cost effective. There were a number of assumptions which if you challenged them would push aspirin outside the cost effectiveness acceptability threshold.
Now with cancer benefits coming through, the extent of variation around our cost effectiveness estimates has been reduced, the estimates are much more precise and much nearer what people would regard as representing value for money. So that’s the point I’m going to make, is that we are now in a position whereby using aspirin in risk groups especially and avoiding aspirin use in those people who are going to perhaps suffer some degree of harm is perceived to be cost effective.
The way in which we’ve done it was to look at the cost of actually generating an additional year of life. The probability that you would get the cost-effectiveness estimate of aspirin as primary prevention had a probability attached to it of just over 50% when you’re looking at the CHD effects as a whole. When you look at the cancer effects the probability factor goes up to over 90%.
