Cost-Effectiveness of Omeprazole for the Primary Prevention of Gastrointestinal Bleeding in Patients on Long-Term Low-Dose Aspirin

Abstract

Purpose: Current guidelines recommend that patients with known cardiovascular disease be treated indefinitely with low-dose aspirin (ASA) for secondary prevention of cardiovascular events. These patients are at increased risk for gastrointestinal (GI) bleeding. Prophylaxis for GI bleeding with a proton-pump inhibitor (PPI) has been shown to be effective in patients with a history of GI bleeding. However, it is unknown whether primary prophylaxis for GI bleeding with omeprazole, a low-cost PPI, is cost-effective. Methods: A Markov model was developed to compare the cost-effectiveness of low-dose ASA alone versus low-dose ASA plus omeprazole. The published literature was used to estimate risks, benefits, and costs. The target population was men and women over the age of 65 requiring ASA indefinitely for secondary prevention of cardiovascular disease. Results: In the base-case analysis, ASA plus omeprazole resulted in fewer bleeding events than ASA alone (4% vs 17% lifetime risk) and fewer bleeding-related deaths than ASA alone (0.3% vs 1.3%). ASA plus omeprazole was more costly than ASA alone, with an incremental cost-effectiveness ratio (ICER) of $33000 per life-year saved (LYS). In one-way sensitivity analysis, varying the annual per-patient cost of omeprazole between $150 and $450 resulted in ICERs of $13000 to $50000 per LYS. Varying the annual bleeding risk from ASA between 0.5% and 1.5% resulted in ICERs of $19000 to $75000 per LYS. Conclusions: Use of omeprazole for the primary prevention of GI bleeding in patients taking low-dose aspirin is cost-effective by traditional standards. Patients being treated with low-dose ASA for secondary prevention of cardiovascular events should be treated with omeprazole to reduce the long-term risk of GI bleeding.