Gastroprotection in Low-Dose Aspirin Users for Primary and Secondary Prevention of ACS: Results of a Cost-Effectiveness
- PDF / 655,179 Bytes
- 17 Pages / 595.276 x 790.866 pts Page_size
- 116 Downloads / 194 Views
ORIGINAL ARTICLE
Gastroprotection in Low-Dose Aspirin Users for Primary and Secondary Prevention of ACS: Results of a Cost-Effectiveness Analysis Including Compliance N. L. de Groot & H. G. M. van Haalen & B. M. R. Spiegel & L. Laine & A. Lanas & J. Jaspers Focks & P. D. Siersema & M. G. H. van Oijen
Published online: 16 February 2013 # Springer Science+Business Media New York 2013
Abstract Purpose Low-dose aspirin (ASA) increases the risk of upper gastrointestinal (GI) complications. Proton pump inhibitors (PPIs) reduce these upper GI side effects, yet patient compliance to PPIs is low. We determined the cost-effectiveness of gastroprotective strategies in low-dose ASA users considering ASA and PPI compliance. Methods Using a Markov model we compared four strategies: no medication, ASA monotherapy, ASA+PPI cotherapy and a fixed combination of ASA and PPI for N. L. de Groot and H. G. M. van Haalen contributed equally to this paper. N. L. de Groot (*) : H. G. M. van Haalen : P. D. Siersema : M. G. H. van Oijen Department Gastroenterology and Hepatology, University Medical Center Utrecht, PO Box (85500 internal code F02.618), 3508 GA Utrecht, The Netherlands e-mail: [email protected] B. M. R. Spiegel Division of Gastroenterology and Hepatology, Veterans Affairs Greater Los Angeles Health Care system, Los Angeles, CA, USA B. M. R. Spiegel : M. G. H. van Oijen University of California Los Angeles/Veterans Affairs Center for Outcomes Research and Education (CORE), Los Angeles, CA, USA L. Laine Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
primary and secondary prevention of ACS. The risk of acute coronary syndrome (ACS), upper GI bleeding and dyspepsia was modeled as a function of compliance and the relative risk of developing these events while using medication. Costs, quality adjusted life years and number of ACS events were evaluated, applying a variable risk of upper GI bleeding. Probabilistic sensitivity analyses were performed. Results For our base case patients using ASA for primary prevention of ACS no medication was superior to ASA monotherapy. PPI co-therapy was cost-effective (incremental costeffectiveness ratio [ICER] €10,314) compared to no medication. In secondary prevention, PPI co-therapy was costeffective (ICER €563) while the fixed combination yielded an ICER < €20,000 only in a population with elevated risk for upper GI bleeding or moderate PPI compliance. PPI cotherapy had the highest probability to be cost-effective in all scenarios. PPI use lowered the overall number of ACS. Conclusions Considering compliance, PPI co-therapy is likely to be cost-effective in patients taking low dose ASA for primary and secondary prevention of ACS, given low PPI prices. In secondary prevention, a fixed combination seems cost-effective in patients with elevated risk for upper GI bleeding or in those with moderate PPI compliance. Both strategies reduced the number of ACS compared to ASA monotherapy. Keywords Cost-effectiven
Data Loading...
