Costeffectiveness of Proton Pump Inhibitor Cother

Authors: Sameer D Saini Philip Schoenfeld A Mark Fendrick James Scheiman

Publish Date: 2008/08/11

Volume: 168, Issue: 15, Pages: 1684-1690

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Abstract

Basic Markov model structure Ovals represent Markov states gastrointestinal GI bleeding is a discrete event that can occur in any living Markov state “ASA + PPI” and “clopidogrel bisulfate + PPI” represent highrisk bleeding states owing to history of bleeding ASA indicates aspirin PPI proton pump inhibitorOneway sensitivity analysis of the relative risk reduction RRR in upper gastrointestinal bleeding UGIB for those taking a proton pump inhibitor in an averagerisk population ICER indicates incremental costeffectiveness ratio The middle line represents the base case and the upper and lower lines represent the extremes of the sensitivity analysis rangeProbabilistic sensitivity analysis of the incremental cost and incremental effectiveness of 10 000 Monte Carlo trials The dashed line represents a willingnesstopay threshold of 50 000 per lifeyear saved with results to the right of the line favoring an aspirin plus proton pump inhibitor strategy Shades of gray represent deciles of the Monte Carlo trial resultsTwoway sensitivity analysis of the relative risk reduction RRR in upper gastrointestinal bleeding UGIB and UGIB risk category averagerisk or 3fold increased risk ICER indicates incremental costeffectiveness ratio The black lines represent the averagerisk group and the blue lines represent the increasedrisk group for various starting agesTwoway sensitivity analysis of the relative risk reduction RRR in upper gastrointestinal bleeding UGIB and UGIB risk category 4× or 8× under prescription proton pump inhibitor cost 1400 per year ICER indicates incremental costeffectiveness ratio The black lines represent the 4× group and the blue lines represent the 8× group for various starting agesSaini SD Schoenfeld P Fendrick AM Scheiman J Costeffectiveness of Proton Pump Inhibitor Cotherapy in Patients Taking Longterm LowDose Aspirin for Secondary Cardiovascular Prevention Arch Intern Med 2008168151684–1690 doi101001/archinte168151684

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