National Meeting 2009

1006 — National Economic Implications of PPI Gastroprotection among Elderly Nonsteroidal Anti-Inflammatory Drug Users

Abraham NS (Houston Center for Quality of Care & Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center) , Hartman C (Houston Center for Quality of Care & Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center), Hasche J (Houston Center for Quality of Care & Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center)

Objectives:
To quantify national health resource cost associated with nonsteroidal anti-inflammatory (NSAID)-related upper gastrointestinal events (UGIE), and to determine the effect of proton pump inhibitors (PPI) on hospitalization and resource use.

Methods:
We identified from national pharmacy records veterans > = 65 years prescribed an 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 VA-Medicare dataset of inpatient, outpatient, and death files, and demographic and provider data. Each person-day of follow-up was assessed for exposure to NSAID alone, NSAID+PPI, coxib, or coxib+PPI, from index prescription until first UGIE. We examined differences in costs for those patients on PPI at any time between index NSAID prescription and UGIE versus those never on PPI. We assessed the effect of prescription strategy on hospitalization using a multivariate logistic regression model.

Results:
A total of 3,566 UGIE 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 the PPI strategy ($9,948,738 vs. $18,686,081).

Implications:
PPI gastroprotection among high-risk elderly is associated with a reduction in hospitalization and medical cost savings for the treatment of UGIE. The resource cost savings is greater than the pharmacy cost for PPI gastroprotection to first UGIE.

Impacts:
When compared with a strategy without PPI gastroprotection, patients provided PPI were 30% less likely to be hospitalized for their NSAID-related UGIE, resulting in a medical resource cost-savings of $8,737,343 when compared with the no-PPI strategy. The observed reduction in medical resource cost outweighs the increase in pharmacy-related costs for the provision of the gastroprotective agent among this cohort.