ASSA 2016: Measuring the benefit of statin use

The United States Preventive Services Task Force (USPSTF) recommends that patients take an aspirin per day to prevent myocardial infarction and ischemic stroke.   At a presentation at the 2016 ASSA meetings, Étienne Gaudette presented results from a study measuring the benefit of implementing the USPSTF recommendation. They find that that there are significant health gains from increased aspirin use. They use data from the Health and Retirement Study (HRS) and NHANES data to simulate the impact of increased use of aspirin using the Future Elderly Model (FEM). Using evidence from the literature, they find that increased use of aspirin would decrease the number of heart attacks and strokes. There are some risks, however. Aspirin thins the blood which will increases the risk of bleeding. Balancing these two offsetting factors, the authors find significant improvement in life expectancy and modest improvements in healthy life expectancy. Further, taking an aspirin a day is highly cost effective.

However, few patients take aspirin.   Why would this be the case? Étienne Gaudette argues that there are a number of potential reasons. First is patient preferences. It could be the cases that few patients want to take a pill every day, despite the health benefits. In this case, it would be optimal (from the patient’s perspective) to not take aspiring despite the health benefits.  Second, patients may not be informed of the true benefit of aspirin.  In this case, a public health campaign to inform patients of the potential benefit would be needed. Third, patients may have “irrational” or hyperbolic preferences, whereby they do not fully take into account the benefits of future health benefits.  In this case, programs to instill habit formation may be helpful.  All three explanations are plausible, but all result in different policy prescriptions.

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