Monday, December 5, 2016

Wider Low-Dose Aspirin Use Would Save U.S. $692 Billion

Taking low-dose aspirin daily can reduce older Americans’ risk of heart disease and cancer, and lead to significant savings in health care spending, a new study contends.

University of Southern California researchers used national data to assess the long-term benefits of daily aspirin usage. They calculated that taking low-dose aspirin every day would prevent 11 cases of heart disease and four cases of cancer for every 1,000 Americans ages 51- to 79.

“Although the health benefits of aspirin are well-established, few people take it,” said study lead author Dr. David Agus. He’s the founding director and CEO of the university’s Lawrence J. Ellison Institute for Transformative Medicine.

“Our study shows multiple health benefits and a reduction in health care spending from this simple, low-cost measure that should be considered a standard part of care for the appropriate patient,” Agus said in a university news release.

“The irony of our findings is that aspirin may be too cheap,” said study co-author Dana Goldman, director of the USD Schaeffer Center for Health Policy and Economics.

“Only 40% of Americans are taking aspirin when they should, and providers have little incentive to push that number up, despite the obvious health benefits and health care savings,” he noted.

“Until we figure out how to reward providers – and manufacturers – for long-term outcomes, no one is going to do anything about this problem,” Goldman said.

Low-dose aspirin isn’t a magic cure-all, however. The study revealed no significant reduction for stroke incidence. It also indicated that gastrointestinal bleeding would increase 25% from the current rate. This means two out of 63 Americans would likely suffer a bleeding incident between ages 51 and 79, the researchers said.

The study results were published Nov. 30 in the journal PLOS ONE.

My Take:
The standard of care for low-dose aspirin is to prescribe it only after a patient has suffered a heart attack. Many studies have shown that the risk of significant side effects in primary prevention are much greater than any possible preventive aspects. That changes once someone has had a heart attack. Then the benefits of secondary prevention make low-dose aspirin a viable treatment option.

Unfortunately, the real issue is not the high percentage of patients that fail to take low-dose aspirin daily after suffering a heart attack. It’s actually the high percentage of physicians that place patients on daily low-dose aspirin with no history of heart attack. Clinically, I see these patients in my practice every day.

Over 100,000 patients are hospitalized each year from GI bleeds associated with the use of NSAIDS, including low-dose aspirin. A recent study showed that every patient has a small GI bleed each and every time they take a low-dose aspirin. Conservative estimates place the number of deaths from NSAID bleeds at 16,500 per year.

The Bottom Line:
If you have suffered a heart attack, please discuss the use of daily low dose aspirin with your PCP or cardiologist. If you have not had a heart attack and are taking low-dose aspirin, then discuss the potential risks with your physician as well.

As a side note, I thought the reward for treating patients effectively was maintaining or restoring the health of the patient. Goldman’s comments just highlight a significant flaw in our health care system – illegal kickbacks from Big Pharm to physicians.

November 30, 2016 National Institutes of Health

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