For patients with clogged heart arteries who take long-term, low-dose aspirin to prevent a cardiac event, adding a stomach acid-blocking drug to their daily routine has been shown to reduce their risk for upper gastrointestinal bleeding - an infrequent, but serious side-effect of regular aspirin use.
But do the benefits of these acid blockers - called proton pump inhibitors, or PPIs - outweigh their long-term costs?
In a new study, researchers at the University of Michigan Health System reveal that, from the perspective of a long-term payer, over-the-counter PPIs are worth the price for coronary heart disease patients taking low-dose aspirin as a preventative measure. At prescription costs, however, PPIs are cost-effective only for elderly patients and patients at high risk for upper GI bleeding.
"Our study was also able to demonstrate that, for patients at an average risk for GI bleeding, starting PPI cotherapy at a younger age was marginally cost-effective, while starting PPI cotherapy at an older age was highly cost effective," says Sameer Dev Saini, M.D., M.S., clinical lecturer in the Division of Gastroenterology at the U-M Medical School. "Ultimately, physicians should discuss the gastrointestinal risks of low-dose aspirin with their patients and consider PPI cotherapy."
Study results appear in the Aug. 11/25 issue of Archives of Internal Medicine.
Coronary heart disease is caused by gradual blockage of the heart arteries, which slows the flow of oxygen and blood to the heart. Because clogged heart arteries put patients at an increased risk for heart attack and sudden death, medical guidelines recommend that they use low-dose aspirin daily to prevent future cardiovascular events. Regular use of asprin, however, poses a small risk for upper gastrointestinal bleeding.
"The stomach normally has a protective coating to prevent acid-related injury. But aspirin and other non-steroidal anti-inflammatory drugs, or NSAIDs, impair the stomach's ability to form this barrier coating, potentially leading to ulcer formation," explains Saini. "Furthermore, these drugs may themselves cause injury directly to stomach cells, and can impair the ability of platelets to form a plug in the event of bleeding."
While not regularly prescribed to coronary heart disease patients who take asprin, Saini says PPIs taken on a daily basis can reduce a patient's risk for upper GI bleeding. In fact, U-M researchers were among the first to reveal that aspirin-related damage could be reduced by a PPI.
"Many Americans are currently taking low-dose aspirin for coronary heart disease, and we know that PPIs are effective in reducing ulcer bleeding in patients on aspirin," says Saini. "What we didn't know, however, was whether it is worth paying for these drugs for patients on low-dose aspirin who had no other risk factors."
With the recent availability of a low-cost OTC PPI - Prilosec OTC - Saini and his colleagues wanted to explore its cost-effectiveness compared to higher-cost prescription PPIs. They also looked at the bigger picture: Is life-long PPI cotherapy cost-effective for patients taking aspirin?
The study revealed: