title: Incremental cost effectiveness of proton pump inhibitors for the prevention of non-steroidal anti-inflammatory drug ulcers: a pharmacoeconomic analysis linked to a case-control study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  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 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 euro 50,094 higher for concomitant PPIs use. The incremental cost effectiveness ratio was euro 4,907 per NSAID ulcer complication prevented when using the least costly PPIs.
  
  
  CONCLUSIONS
  Concomitant use of PPIs for the prevention of NSAID ulcer complications costs euro 4,907 per NSAID ulcer complication prevented when using the least costly PPIs. The price of PPIs highly influenced the robustness of the results.
authors.affiliation: Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente and University of Twente, Enschede, The Netherlands. h.vonkeman@ziekenhuis-mst.nl
authors.forename: Harald E
authors.initials: HE
authors.lastname: Vonkeman
authors.forename: Louise M A
authors.initials: LM
authors.lastname: Braakman-Jansen
authors.forename: Rogier M
authors.initials: RM
authors.lastname: Klok
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
authors.forename: Jacobus R B J
authors.initials: JR
authors.lastname: Brouwers
authors.forename: Mart A F J
authors.initials: MA
authors.lastname: van de Laar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000191:economics / Q000494:pharmacology* / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000191:economics* / Q000494:pharmacology* / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000139:chemically induced / Q000191:economics* / Q000517:prevention & control*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors