OBJECTIVES

Aspirin use was recommended for prevention of initial vascular events, especially in patients at high-risk of cardiovascular disease. Long-term use of aspirin was associated with increased risks of gastrointestinal and extracranial bleeds. The present study aims to examine the clinical and economic outcomes of aspirin for primary prevention of cardiovascular events in Chinese patients with diabetes.

METHODS

A lifelong Markov model was designed to simulate two strategies (receiving aspirin 100mg daily or no treatment) in a hypothetical cohort of 60-year-old patients with diabetes. Model inputs were mainly derived from published literature and sensitivity analyses were performed to evaluate the robustness of model results. Direct medical costs, quality-adjusted life-years (QALYs) gained, and incremental cost-effectiveness ratio (ICER) were primary outcomes included in the study from the perspective of Chinese healthcare system. All costs and QALYs were discounted to year 2019 with an annual rate of 3%.

RESULTS

Base-case results showed receiving aspirin for primary prevention gained more QALYs (14.4183 QALYs versus 14.2133 QALYs) at higher cost (USD2,455 versus 1,995 USD) at) compared to no treatment. Receiving aspirin was cost-effective with ICER of 2,244 USD/QALY less than 9,860 USD/QALY (1*GDP per capita in China) of the willingness-to-pay threshold. One-way sensitivity analysis found aspirin use was not cost-effective when the odds ratio of all-cause death of aspirin versus no treatment in patients with diabetes exceeded from 0.94 to 1.011. In probabilistic sensitivity analysis, aspirin use was USD451 (95% CI: USD449-USD453, p<0.01) more costly and gained 0.1869 (95% CI: 0.1847-0.1891, p<0.01) higher QALYs compared to no treatment. Aspirin use was cost-effective in 93.43% of 10,000 Monte Carlo simulations.

CONCLUSIONS

Aspirin use for primary prevention of cardiovascular events appears to be a cost-effective strategy in Chinese patients with diabetes.