Long-term acid reflux therapy can be cost-effective

NEW YORK (Reuters Health) - In patients taking aspirin to lower their risk of having a heart attack or stroke, lifelong therapy with a proton pump inhibitor (PPI), which includes drugs such as Nexium or Prilosec, can be a cost-effective means of reducing the risk of upper gastrointestinal bleeding, according to a report in the Archives of Internal Medicine.

For patients with a high risk of gastrointestinal bleeding, this treatment is nearly always cost effective, the report indicates. For patients with only an average risk for bleeding, however, this therapy is only cost effective if PPIs are purchased at over-the-counter costs, rather than as a prescription.

In their study, Dr. Sameer D. Saini, from the University of Michigan Medical School in Ann Arbor, and colleagues developed a statistical model to assess the cost-effectiveness of PPI therapy in coronary heart disease patients who were at least 50 years of age and were taking aspirin.

In a second analysis, the researchers assumed that the patients began taking aspirin with or without PPI therapy at 65 years of age. In addition, they also assumed that the patients had an average risk of bleeding and that PPI therapy was 66-percent effective and cost $250 annually.

The analysis found that adding PPI therapy reduced the lifetime rates of upper gastrointestinal bleeding, from 9.5 percent to 3.1 percent, and upper gastrointestinal bleeding-related death rates from 1.4 percent to 0.4 percent.

In this analysis, which used over-the-counter PPI prices, aspirin plus PPI therapy was cost-effective, but as PPI effectiveness increased and patients' starting age became older, it became less cost-effective.

With PPI prescriptions, the cost-effectiveness was consistently high for average-risk patients. In high-risk patients, by contrast, the cost-benefit ratio was lower.

More studies are needed to better assess the effectiveness of PPI in reducing upper gastrointestinal bleeding in average-risk patients who are also on daily aspirin, and the impact of PPI treatment on aspirin-related indigestion, Saini's team concludes.

SOURCE: Archives of Internal Medicine, August 11-25, 2008.