The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older.
The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older.
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DOI：
10.1371/journal.pone.0166103
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Messali A
中科院分区：
文献类型：
--
作者：
Agus DB;Gaudette É;Goldman DP;Messali A
阿司匹林在预防心血管疾病方面的作用在初级和二级环境中得到了医学界的广泛认可。多项研究还发现，每天服用阿司匹林可以显著降低癌症的发病率和死亡率。尽管这些已被证明的健康益处，阿司匹林的使用在心血管预防指南所针对的人群中仍然很低。本文旨在确定长期的经济和人口健康的影响，更广泛地使用阿司匹林的老年人在心血管疾病的高风险。我们采用了未来老年人模型，这是一个动态的微观模拟，跟踪50岁及以上的美国人，以预测他们在现状和扩大阿司匹林使用的各种情况下的终身健康和支出。该模型主要基于健康和退休研究的数据，这是一项大型的，具有代表性的全国性调查，已经持续了二十多年。选择结果是为了提供干预措施对个人和社会影响的广泛视角，包括：心脏病、中风、癌症、预期寿命、质量调整预期寿命、无残疾预期寿命和医疗费用。在模拟中增加阿司匹林使用的资格是基于2011-2012年国家健康和营养检查调查的预防性阿司匹林使用问卷。这些数据揭示了每日阿司匹林的大量未满足需求，超过40%的男性和10%的50至79岁的女性存在高心血管风险，但不服用阿司匹林。我们估计，增加高风险老年美国人的使用将使50岁时的国民预期寿命提高0.28年（95% CI 0.08-0.50），并将在2036年前增加90万人（95% CI 30万-140万）。在适当评估质量调整生命年后，美国人可以预期在此期间获得6920亿美元（95% CI 345-975）的净健康收益。心血管疾病风险升高的美国老年人扩大使用阿司匹林可以在未来20年内产生大量的人口健康益处，并且非常具有成本效益。
The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease. We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011–2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08–0.50) and would add 900,000 people (95% CI 300,000–1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345–975) in net health benefits over that period. Expanded use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively.
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