Aspirin, statins, or both drugs for the primary prevention of coronary heart disease events in men: a cost-utility analysis

Ann Intern Med. 2006 Mar 7;144(5):326-36. doi: 10.7326/0003-4819-144-5-200603070-00007.


Background: Aspirin and statins are both effective for primary prevention of coronary heart disease (CHD), but their combined use has not been well studied.

Objective: To perform a cost-utility analysis of the effects of aspirin therapy, statin therapy, combination therapy with both drugs, and no pharmacotherapy for the primary prevention of CHD events in men.

Design: Markov model.

Data sources: Published literature.

Target population: Middle-aged men without a history of cardiovascular disease at 6 levels of 10-year risk for CHD (2.5%, 5%, 7.5%, 10%, 15%, and 25%).

Time horizon: Lifetime.

Perspective: Third-party payer.

Interventions: Low-dose aspirin, a statin, both drugs as combination therapy, or no therapy.

Outcome measure: Cost per quality-adjusted life-year gained.

Results of base-case analysis: For 45-year-old men who do not smoke, are not hypertensive, and have a 10-year risk for CHD of 7.5%, aspirin was more effective and less costly than no treatment. The addition of a statin to aspirin therapy produced an incremental cost-utility ratio of 56,200 dollars per quality-adjusted life-year gained compared with aspirin alone.

Results of sensitivity analysis: Excess risk for hemorrhagic stroke and gastrointestinal bleeding with aspirin, risk for CHD, the cost of statins, and the disutility of taking medication had important effects on the cost-utility ratios.

Limitations: Several input parameters, particularly adverse event rates and utility values, are supported by limited empirical data. Results are applicable to middle-aged men only.

Conclusions: Compared with no treatment, aspirin is less costly and more effective for preventing CHD events in middle-aged men whose 10-year risk for CHD is 7.5% or higher. The addition of a statin to aspirin therapy becomes more cost-effective when the patient's 10-year CHD risk before treatment is higher than 10%.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aspirin / adverse effects
  • Aspirin / economics*
  • Aspirin / therapeutic use*
  • Computer Simulation
  • Coronary Disease / prevention & control*
  • Cost-Benefit Analysis
  • Drug Costs
  • Drug Therapy, Combination
  • Fibrinolytic Agents / adverse effects
  • Fibrinolytic Agents / economics*
  • Fibrinolytic Agents / therapeutic use*
  • Gastrointestinal Hemorrhage / chemically induced
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / economics*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Male
  • Markov Chains
  • Middle Aged
  • Primary Prevention
  • Quality-Adjusted Life Years
  • Risk Factors
  • Sensitivity and Specificity
  • Stroke / chemically induced


  • Fibrinolytic Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Aspirin