At over-the-counter cost, proton pump inhibitor (PPI) co-therapy is cost-effective in average-risk patients taking low-dose aspirin for secondary prevention of cardiovascular prophylaxis; and for high-risk patients, co-therapy is only cost-effective at prescription cost, according to a study in the Aug. 11/25 issue of the Archives of Internal Medicine.
"Our study demonstrates that, provided that PPIs are available at OTC prices, PPI co-therapy is a cost-effective strategy for patients older than 65 years who are taking aspirin for secondary prevention and may be cost-effective for patients as young as 50 years," the authors wrote. They added that further “studies are needed to better quantify the effectiveness of PPI co-therapy in reducing [upper GI bleeding (UGIB)] in average-risk patients as well as the impact of PPI co-therapy on ASA-related dyspepsia and compliance.”
Sameer D. Saini, MD, from the departments of internal medicine and gastroenterology at the University of Michigan Medical School in Ann Arbor, Mich., and colleagues developed a Markov model to compare lifelong therapy with aspirin alone compared with therapy with aspirin plus PPI in patients with coronary heart disease who are at least 50 years old.
According to the investigators, base-case assumptions were: starting age, 65 years; UGIB risk category, average risk (range, average to 8-fold increased risk); PPI effectiveness (66 percent); and an annual PPI cost of $250.
In the base-case analysis, Saini and colleagues found that aspirin plus PPI resulted in fewer lifetime UGIB events (3.1 vs. 9.5 percent) and UGIB-related deaths (0.4 vs. 1.4 percent).
At over-the-counter PPI cost, the researchers found that aspirin plus PPI was cost-effective, with an incremental cost-effectiveness ratio (ICER) of $40,090 per life-year saved (LYS).
Varying PPI effectiveness from 75 to 25 percent resulted in ICERs of $35,315 to $94,578 per LYS, the authors wrote. Varying the starting age of the cohort from 80 to 50 years resulted in ICERs of $16,887 to $79,955 per LYS. At prescription PPI cost, the ICER for average-risk patients was more than $100,000 per LYS across all modeled age groups and assumptions of PPI effectiveness, but the ICER for high-risk patients was $10,433 to $51,505 per LYS, according to Saini and colleagues.
The authors acknowledged patient tolerance and adherence to therapy and an absence of adverse effects with long-term PPI therapy as a limitation of their trial.