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Comparative Study
. 2011 Feb 14;171(3):218-25.
doi: 10.1001/archinternmed.2010.525.

Cost-utility of aspirin and proton pump inhibitors for primary prevention

Stephanie R Earnshaw  1 , James Scheiman, A Mark Fendrick, Cheryl McDade, Michael Pignone
Affiliations
Comparative Study

Cost-utility of aspirin and proton pump inhibitors for primary prevention

Stephanie R Earnshaw et al. Arch Intern Med. .

Abstract

Background: Aspirin reduces myocardial infarction but increases gastrointestinal tract (GI) bleeding. Proton pump inhibitors (PPIs) may reduce upper GI bleeding. We estimate the cost-utility of aspirin treatment with or without a PPI for coronary heart disease (CHD) prevention among men at different risks for CHD and GI bleeding.

Methods: We updated a Markov model to compare costs and outcomes of low-dose aspirin plus PPI (omeprazole, 20 mg/d), low-dose aspirin alone, or no treatment for CHD prevention. We performed lifetime analyses in men with different risks for cardiovascular events and GI bleeding. Aspirin reduced nonfatal myocardial infarction by 30%, increased total stroke by 6%, and increased GI bleeding risk 2-fold. Adding a PPI reduced upper GI bleeding by 80%. Annual aspirin cost was $13.99; the generic PPI cost was $200.00.

Results: In 45-year-old men with a 10-year CHD risk of 10% and 0.8 per 1000 annual GI bleeding risk, aspirin ($17,571 and 18.67 quality-adjusted life-years [QALYs]) was more effective and less costly than no treatment ($18,483 and 18.44 QALYs). Compared with aspirin alone, aspirin plus PPI ($21,037 and 18.68 QALYs) had an incremental cost per QALY of $447,077. Results were similar in 55- and 65-year-old men. The incremental cost per QALY of adding a PPI was less than $50,000 per QALY at annual GI bleeding probabilities greater than 4 to 6 per 1000.

Conclusions: Treatment with aspirin for CHD prevention is less costly and more effective than no treatment in men older than 45 years with greater than 10-year, 10% CHD risks. Adding a PPI is not cost-effective for men with average GI bleeding risk but may be cost-effective for selected men at increased risk for GI bleeding.

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Conflict of interest statement

Conflicts of Interest

Dr. Scheiman is Professor of Medicine in the Division of Gastroenterology at the University of Michigan. Dr. Fendrick is Professor of Internal Medicine and Health Management and Policy at the University of Michigan. Drs. Scheiman and Fendrick are paid consultants to RTI Health Solutions. Dr. Scheiman also is a consultant to AstraZeneca, Bayer Inc., Pozen, Inc., as well as other pharmaceutical companies with products not relevant to this work. Dr. Earnshaw and Ms. McDade are employees of RTI Health Solutions, an independent contract research organization that has received research funding for this and other studies from Bayer, Inc. and other pharmaceutical companies that market drugs to prevent cardiovascular events and other conditions. Dr. Pignone is Professor of Medicine and Division Chief for General Internal Medicine at the University of North Carolina at Chapel Hill. His effort was supported by the Foundation for Informed Medical Decision Making and a K05 Established Investigator Award from the National Cancer Institute.

Bayer, Inc. did not participate in the development of the model or in the collection, management, analysis, and interpretation of the data. The preparation and editing of the manuscript was performed solely by the authors. Bayer received a copy of the draft manuscript but had no role in decisions about submission and revision.

Figures

Figure 1
Figure 1. Effect of Change in Baseline Gastrointestinal Bleed Risk in a 45-Year-Old Man With a 10-Year, 10% CHD Risk
Figure 1a: Aspirin Versus No Treatment Figure 1b: Aspirin+PPI Versus Aspirin Alone CHD = coronary heart disease; PPI = proton pump inhibitor; QALY = quality-adjusted life-year.
Figure 1
Figure 1. Effect of Change in Baseline Gastrointestinal Bleed Risk in a 45-Year-Old Man With a 10-Year, 10% CHD Risk
Figure 1a: Aspirin Versus No Treatment Figure 1b: Aspirin+PPI Versus Aspirin Alone CHD = coronary heart disease; PPI = proton pump inhibitor; QALY = quality-adjusted life-year.
Figure 2
Figure 2. One-Way Sensitivity Analysis: 45-Year-Old Man With a 10-Year, 10% CHD Risk
Figure 2a: Aspirin Versus No Treatment Figure 2b: Aspirin+PPI Versus Aspirin Alone CHD = coronary heart disease; CVD = cardiovascular disease; HS = health state; MI = myocardial infarction; PPI = proton pump inhibitor; QALY = quality-adjusted life-year.
Figure 2
Figure 2. One-Way Sensitivity Analysis: 45-Year-Old Man With a 10-Year, 10% CHD Risk
Figure 2a: Aspirin Versus No Treatment Figure 2b: Aspirin+PPI Versus Aspirin Alone CHD = coronary heart disease; CVD = cardiovascular disease; HS = health state; MI = myocardial infarction; PPI = proton pump inhibitor; QALY = quality-adjusted life-year.
Figure 3
Figure 3. Probabilistic Sensitivity Analysis: 45-Year-Old Man With a 10-Year, 10% CHD Risk
Figure 3a: Aspirin Versus No Treatment Figure 3b: Aspirin+PPI Versus Aspirin Alone CHD = coronary heart disease; PPI = proton pump inhibitor; QALY = quality-adjusted life-year.
Figure 3
Figure 3. Probabilistic Sensitivity Analysis: 45-Year-Old Man With a 10-Year, 10% CHD Risk
Figure 3a: Aspirin Versus No Treatment Figure 3b: Aspirin+PPI Versus Aspirin Alone CHD = coronary heart disease; PPI = proton pump inhibitor; QALY = quality-adjusted life-year.
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References

    1. US Preventive Services Task Force (USPSTF) Aspirin for the prevention of cardiovascular disease: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;150:396–404. - PubMed
    1. Bhatt DL, Scheiman J, Abraham NS, et al. and the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation. 2008;118(18):1894–1909. - PubMed
    1. Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use. N Engl J Med. 2002;346(26):2033–2038. - PubMed
    1. Saini SD, Schoenfeld P, Fendrick AM, Scheiman J. Cost-effectiveness of proton pump inhibitor cotherapy in patients taking long-term, low-dose aspirin for secondary cardiovascular prevention. Arch Intern Med. 2008;168(15):1684–1690. 1691. - PubMed
    1. Pignone M, Earnshaw S, Tice JA, Pletcher MJ. Aspirin, statins, or both drugs for the primary prevention of coronary heart disease events in men: a cost-utility analysis. Ann Intern Med. 2006;144(5):326–336. - PubMed

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