Abstract
IntroductionWe estimated the cost effectiveness of concomitant proton pump inhibitors (PPIs) in relation to the occurrence of non-steroidal anti-inflammatory drug (NSAID) ulcer complications.MethodsThis study was linked to a nested case-control study. Patients with NSAID ulcer complications were compared with matched controls. Only direct medical costs were reported. For the calculation of the incremental cost effectiveness ratio we extrapolated the data to 1,000 patients using concomitant PPIs and 1,000 patients not using PPIs for 1 year. Sensitivity analysis was performed by 'worst case' and 'best case' scenarios in which the 95% confidence interval (CI) of the odds ratio (OR) and the 95% CI of the cost estimate of a NSAID ulcer complication were varied. Costs of PPIs was varied separately.ResultsIn all, 104 incident cases and 284 matched controls were identified from a cohort of 51,903 NSAID users with 10,402 NSAID exposition years. Use of PPIs was associated with an adjusted OR of 0.33 (95% CI 0.17 to 0.67; p = 0.002) for NSAID ulcer complications. In the extrapolation the estimated number of NSAID ulcer complications was 13.8 for non-PPI users and 3.6 for PPI users. The incremental total costs were € 50,094 higher for concomitant PPIs use. The incremental cost effectiveness ratio was € 4,907 per NSAID ulcer complication prevented when using the least costly PPIs.ConclusionsConcomitant use of PPIs for the prevention of NSAID ulcer complications costs € 4,907 per NSAID ulcer complication prevented when using the least costly PPIs. The price of PPIs highly influenced the robustness of the results.
Highlights
We estimated the cost effectiveness of concomitant proton pump inhibitors (PPIs) in relation to the occurrence of non-steroidal anti-inflammatory drug (NSAID) ulcer complications
In all, 104 incident cases and 284 matched controls were identified from a cohort of 51,903 NSAID users with 10,402 NSAID exposition years
Use of PPIs was associated with an adjusted odds ratio (OR) of 0.33 for NSAID ulcer complications
Summary
We estimated the cost effectiveness of concomitant proton pump inhibitors (PPIs) in relation to the occurrence of non-steroidal anti-inflammatory drug (NSAID) ulcer complications. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is known to be complicated by serious gastrointestinal toxicity. NSAIDs impair prostaglandin-dependent gastric mucosal protective mechanisms. When these defences have been breached, a second wave of injury caused by luminal gastric acid may facilitate deep ulceration, eventually causing ulcer bleeding and perforation [1]. Several strategies have been developed to prevent NSAID ulcers [2,3]. In clinical trials different selective cyclooxygenase (COX)-2 inhibitors, proton pump inhibitors (PPIs), high dose histamine-2 receptor antagonists and prostaglandin analogues have been shown to decrease the risk for NSAID ulcers. Few strategies have been directly compared, and for most a formal cost effectiveness analysis is lacking
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