title: Reduced hospitalization cost for upper gastrointestinal events that occur among elderly veterans who are gastroprotected.
abstract: OBJECTIVE
  Despite prescription of gastroprotection among elderly nonsteroidal anti-inflammatory drug (NSAID) users, residual bleeding can still occur. We sought to determine the effect of proton pump inhibitors (PPI) on hospitalization and resource use among veterans in whom an upper gastrointestinal event (UGIE) occurred.
  
  
  METHODS
  We identified from national pharmacy records veterans > or =65 years prescribed an NSAID, cyclooxygenase-2 selective NSAID (coxib), or salicylate (>325 mg/day) at any Veterans Affairs (VA) facility (01/01/00-12/31/04). Prescription fill data were linked longitudinally to a Veterans Affairs-Medicare dataset of inpatient, outpatient, and death files, and demographic and provider data. Among veterans in whom a UGIE occurred, we assessed the effect of prescription strategy on hospitalization, using a multivariate logistic regression model.
  
  
  RESULTS
  A total of 3566 UGIEs occurred among a cohort that was predominantly male (97.5%), white (77%), with a mean age of 73.5 (SD, 5.7). Hospitalization occurred in 47.5%, and gastroprotection was associated with a 30% reduction in hospitalization compared with no PPI. Five-year pharmacy costs associated with the PPI strategy exceeded the no-PPI strategy ($742,406 vs $184,282); however, a substantial reduction in medical costs was observed with PPI ($9,948,738 vs $18,686,081).
  
  
  CONCLUSIONS
  Even if an NSAID-UGIE occurs in the PPI-protected older veteran, the reduction in need for hospitalization results in a cost saving to the Department of Veterans Affairs.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA. nabraham@bcm.edu
authors.forename: Neena S
authors.initials: NS
authors.lastname: Abraham
authors.forename: Christine
authors.initials: C
authors.lastname: Hartman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hasche
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use*; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000473:pathology / Q000517:prevention & control*; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012459:Salicylates / Q000009:adverse effects / Q000627:therapeutic use; D014728:Veterans
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D054328:Proton Pump Inhibitors; D012459:Salicylates