Cost-Utility Analysis of Proton Pump Inhibitors and Other Gastro-Protective Agents for Prevention of Gastrointestinal Complications in Elderly Patients Taking Nonselective Nonsteroidal Anti-inflammatory Agents

Authors: 
C. Cameron, S.V. Van Zanten, C. Skedgel, G. Flowerdew, P. Moayyedi, I. Sketris
Research Summary: 

Background
The use of proton pump inhibitors (PPIs) among elderly patients using nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs) has increased; the price of PPIs is higher than that of majority of alternative treatment strategies.

Aim
To evaluate the cost-effectiveness of nsNSAIDS + PPIs relative to alternative gastroprotective regimens in the prevention of GI complications among elderly patients (aged ≥65 years).

Methods
An incremental cost-utility analysis, comparing PPIs with alternative gastroprotective regimens was conducted using a decision analytica model. Clinical outcomes, costs and utilities were derived from recently published studies. Probabilistic and deterministic sensitivity analyses were performed to test the robustness of the results to variation inmodel inputs and assumptions.

Results
The incremental cost-utility ratio (ICUR) of PPIs, relative to nsNSAIDalone, was $206 315 per QALY gained or were more costly and less effective. Other co-prescribed treatment options had higher costs perQALY gained. In patients with a history of a complicated or uncomplicated ulcer, PPIs had ICURs of $24 277 and $40 876, respectively.

Conclusions
Use of PPIs in all elderly patients taking nsNSAIDs is unlikely to representan efficient use of finite healthcare resources. Co-prescribing PPIs, however,to elderly patients taking nsNSAIDs who have a history of complicatedor uncomplicated ulcers appears to be economically attractive.