Cost effectiveness of aspirin plus PPI for primary prevention

January 01, 0001

Cost effectiveness of aspirin plus PPI for primary prevention

These US authors estimated the cost-utility of aspirin treatment with or without a proton pump inhibitor (PPI) for coronary heart disease (CHD) prevention among men at different risks for CHD and GI bleeding. They 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. They 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.

They found: "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."

The authors concluded: "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."

This study did not take into account potential increases in risks due to PPI use, such as pneumonia and osteoporosis.

For the full abstract, click here.

Arch Intern Med 171(3):218-225, 14 February 2011
© 2011 to the American Medical Association
Cost-Utility of Aspirin and Proton Pump Inhibitors for Primary Prevention. Stephanie R. Earnshaw, James Scheiman, A. Mark Fendrick, Cheryl McDade; Michael Pignone. Correspondence to Dr. Earnshaw:

Category: K. Circulatory, D. Digestive. Keywords: coronary artery disease, primary prevention, aspirin, proton pump inhibitor, omeprazole, cost-effectiveness analysis, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 1 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.