Abstract
Objective American College of Cardiology and American Heart Association (ACC/AHA) published
new guidelines which lower the cut-off for hypertension. We sought to evaluate the
impact of these guidelines to cost and benefit of various low-dose aspirin prophylaxis
approaches.
Study Design Decision tree analysis was created using R software to evaluate four approaches to
aspirin prophylaxis in the United States: no aspirin, United States Preventive Service
Task Force (USPSTF) with Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) hypertension guidelines,
USPSTF with ACC/AHA hypertension guidelines, as well as universal aspirin prophylaxis.
This model was executed to simulate a hypothetical cohort of 4 million pregnant women
in the United States.
Results The new guidelines would expand the aspirin eligibility by 8% (76,953 women) in the
USPSTF guidelines. Even with this increased eligibility, the USPSTF guidelines continue
to be the approach with the most cost savings ($386.5 million) when compared with
universal aspirin and no aspirin prophylaxis. The new hypertension guidelines are
projected to increase the cost savings of the USPSTF approach by $9.4 million.
Conclusion Despite the small change in aspirin prophylaxis, using ACC/AHA definition of hypertension
still results in an annual cost-saving of $9.4 million in the United States when compared
with JNC7.
Keywords
cost-benefit analysis - low-dose aspirin - preeclampsia prophylaxis - hypertension
guidelines
