In individuals age 40 and older who have been newly diagnosed with type 2 diabetes, regular aspirin use is a cost-effective strategy, according to a study in the June issue of Diabetes Care.
Rui Li, Ph.D., of the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues used a Markov disease progression model of type 2 diabetes to evaluate the cost-effectiveness of the daily use of aspirin (80 mg) in adults aged 40 to 94 who were newly diagnosed in 2006. The model analyzed lifetime costs for five typical diabetes complications: neuropathy, nephropathy, retinopathy, coronary heart disease and stroke.
The researchers found that aspirin users gained 0.31 life-years or 0.19 quality-adjusted life-years (QALYs) over a lifetime compared with those not taking aspirin; the incremental cost was $1,700.
The incremental cost-effectiveness ratio (ICER) of aspirin use was $5,428 per life-year gained or $8,801 per QALY gained.
“Medicare and Medicaid programs cover many drugs and medical technologies with much higher ICERs than our estimated ICERs for aspirin. If we use the conventional $50,000/QALY as the threshold for cost-effectiveness, aspirin use is a very cost-effective intervention for people with newly diagnosed diabetes,” the authors write.
OBJECTIVE To assess the long-term cost-effectiveness of aspirin use among adults aged – 40 years with newly diagnosed type 2 diabetes.
RESEARCH DESIGN AND METHODS We used a validated cost-effectiveness model of type 2 diabetes to assess the lifetime health and cost consequences of use or nonuse of aspirin. The model simulates the progression of diabetes and accompanying complications for a cohort of subjects with type 2 diabetes. The model predicts the outcomes of type 2 diabetes along five disease paths (nephropathy, neuropathy, retinopathy, coronary heart disease, and stroke) from the time of diagnosis until age 94 years or until death.
RESULTS Over a lifetime, aspirin users gained 0.31 life-years (LY) or 0.19 quality-adjusted LYs (QALYs) over nonaspirin users, at an incremental cost of $1,700; the incremental cost-effectiveness ratio (ICER) of aspirin use was $5,428 per LY gained or $8,801 per QALY gained. In probabilistic sensitivity analyses, the ICER was <$30,000 per QALY in all of 2,000 realizations in two scenarios. CONCLUSIONS Regular use of aspirin among people with newly diagnosed diabetes is cost-effective.
# Rui Li, PHD,
# Ping Zhang, PHD,
# Lawrence E. Barker, PHD and
# Thomas J. Hoerger, PHD