For patients with clogged heart arteries who take long-term, low-dose aspirin to prevent a cardiac event, adding a stomach acid-blocking drug to their daily routine has been shown to reduce their risk for upper gastrointestinal bleeding – an infrequent, but serious side-effect of regular aspirin use.
But do the benefits of these acid blockers – called proton pump inhibitors, or PPIs – outweigh their long-term costs?
In a new study, researchers at the University of Michigan Health System reveal that, from the perspective of a long-term payer, over-the-counter PPIs are worth the price for coronary heart disease patients taking low-dose aspirin as a preventative measure. At prescription costs, however, PPIs are cost-effective only for elderly patients and patients at high risk for upper GI bleeding.
"Our study was also able to demonstrate that, for patients at an average risk for GI bleeding, starting PPI cotherapy at a younger age was marginally cost-effective, while starting PPI cotherapy at an older age was highly cost effective," says Sameer Dev Saini, M.D., M.S., clinical lecturer in the Division of Gastroenterology at the U-M Medical School. "Ultimately, physicians should discuss the gastrointestinal risks of low-dose aspirin with their patients and consider PPI cotherapy."
Study results appear in the Aug. 11/25 issue of Archives of Internal Medicine.
Coronary heart disease is caused by gradual blockage of the heart arteries, which slows the flow of oxygen and blood to the heart.
Because clogged heart arteries put patients at an increased risk for heart attack and sudden death, medical guidelines recommend that they use low-dose aspirin daily to prevent future cardiovascular events.
Regular use of asprin, however, poses a small risk for upper gastrointestinal bleeding.
"The stomach normally has a protective coating to prevent acid-related injury. But aspirin and other non-steroidal anti-inflammatory drugs, or NSAIDs, impair the stomach's ability to form this barrier coating, potentially leading to ulcer formation," explains Saini. "Furthermore, these drugs may themselves cause injury directly to stomach cells, and can impair the ability of platelets to form a plug in the event of bleeding."
While not regularly prescribed to coronary heart disease patients who take asprin, Saini says PPIs taken on a daily basis can reduce a patient's risk for upper GI bleeding. In fact, U-M researchers were among the first to reveal that aspirin-related damage could be reduced by a PPI.
"Many Americans are currently taking low-dose aspirin for coronary heart disease, and we know that PPIs are effective in reducing ulcer bleeding in patients on aspirin," says Saini. "What we didn't know, however, was whether it is worth paying for these drugs for patients on low-dose aspirin who had no other risk factors."
With the recent availability of a low-cost OTC PPI – Prilosec OTC© – Saini and his colleagues wanted to explore its cost-effectiveness compared to higher-cost prescription PPIs. They also looked at the bigger picture: Is life-long PPI cotherapy cost-effective for patients taking aspirin?
The study revealed:At OTC prices, PPI cotherapy is cost-effective for patients older than 65 who are taking low-dose aspirin, and may also be cost-effective for patients as young as 50.
Implications: Although studies have demonstrated its effectiveness in preventing upper GI bleeding in patients taking regular aspirin, PPI therapy ultimately will create an added cost to patients and insurers. This study addresses the question of whether the benefit of PPIs are worth this added cost. However, it is important to keep in mind that many patients also may not enjoy needing to take an additional medication every day, notes Saini, an issue not addressed by this study. Recent studies also have raised concerns about potential long-term side effects of PPIs – community acquired pneumonia and hip fractures caused by osteoporosis – although Saini says more study is need on this issue.
Methodology: The researchers used a computer model to simulate the lifetime risk of ulcer bleeding events in patients taking aspirin, using available literature to estimate the risk. Risk was modified based on whether or not a PPI was being concurrently taken by the patient. Then, the total lifetime costs and life expectancy were tallied for those patients taking aspirin alone (PPI was only started if bleeding occurred), and patients taking daily aspirin plus a PPI. Based on those results, the cost per additional year of life saved under the PPI strategy was calculated.
Krista Hopson | EurekAlert!
Team discovers how bacteria exploit a chink in the body's armor
20.01.2017 | University of Illinois at Urbana-Champaign
Rabies viruses reveal wiring in transparent brains
19.01.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn
For the first time ever, a cloud of ultra-cold atoms has been successfully created in space on board of a sounding rocket. The MAIUS mission demonstrates that quantum optical sensors can be operated even in harsh environments like space – a prerequi-site for finding answers to the most challenging questions of fundamental physics and an important innovation driver for everyday applications.
According to Albert Einstein's Equivalence Principle, all bodies are accelerated at the same rate by the Earth's gravity, regardless of their properties. This...
An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...
Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...
Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.
While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...
Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales
Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...
19.01.2017 | Event News
10.01.2017 | Event News
09.01.2017 | Event News
23.01.2017 | Process Engineering
23.01.2017 | Physics and Astronomy
23.01.2017 | Life Sciences