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Instructor in Medicine, Harvard Medical School; Senior Scientist, Institute for Technology Assessment and Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA
Associate Professor of Medicine, Harvard Medical School; Institute for Technology Assessment, Massachusetts General Hospital; Beth Israel Deaconess Medical Center, Boston
Associate Professor of Radiology, Harvard Medical School; Director, Institute for Technology Assessment, Massachusetts General Hospital
Reprints: Dr. Hur, MGH Institute for Technology Assessment, 101 Merrimac St., 10th Fl., Boston, MA 02114-4719, fax 617/726-9414, chur{at}mgh-ita.org
BACKGROUND: Aspirin therapy is widely accepted for patients with documented cardiovascular disease, but there is a growing trend among healthy individuals to use aspirin as primary prevention for both cardiovascular disease and cancer.
OBJECTIVE: To determine the impact of the complications of aspirin therapy on quality-adjusted life-years (QALYs) in healthy individuals.
METHODS: A computer-based decision-analytic model was constructed. In this model, healthy individuals taking aspirin were assumed to receive no advantages from the aspirin, but were at risk of developing its associated complications. Individuals took 325 mg of enteric-coated aspirin every day until death, discontinuing therapy only if an aspirin-induced complication occurred. The analysis was performed from a societal perspective, starting at age 50 years. Extensive sensitivity analyses were performed.
RESULTS: In the absence of any beneficial effect, aspirin reduced QALYs by 0.03 per individual. Unadjusted life expectancy was decreased by 0.04 years (2 wk). Lifetime aspirin use cost an average of $460/healthy person. The total complication rate over a lifetime of aspirin therapy was 6.79%, with a mortality rate of 0.18%. Alternatively stated, there was one complication for every 15 individuals treated and one death for every 556 individuals treated. Extensive sensitivity analysis showed the range of results possible when varying age, gender, length of follow-up, and other key parameters.
CONCLUSIONS: Assuming no benefits, aspirin therapy in healthy individuals leads to a small reduction in QALYs at an overall low cost per person. However, approximately 1 in 15 individuals will experience an aspirin-induced complication and 1 in 556 individuals will die.
Key Words: aspirin, chemoprevention, risk analysis
Published Online, December 8, 2004. www.theannals.com, DOI 10.1345/aph.1E115
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  J. T. Cohen and P. J. Neumann What's More Dangerous, Your Aspirin Or Your Car? Thinking Rationally About Drug Risks (And Benefits) Health Aff., May 1, 2007; 26(3): 636 - 646. [Abstract] [Full Text] [PDF]
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