De kosteneffectiviteit van maagbescherming met protonpompremmers bij gebruikers van laaggedoseerde salicylaten

Sek Hung Chau, Reinier L. Sluiter, Wietske Kievit, Michel Wensing, Maxtina Teichert, Jacqueline G. Hugtenburg

Research output: Contribution to journalArticleProfessional

Abstract

OBJECTIVE: The present study aimed to assess the cost-effectiveness of concomitant proton pump inhibitor |PPI) treatment in low dose acetylsalicylic acid (LDASA) users at risk of upper gastrointestinal (UGI) side effects as compared to no PPI co-medication with attention to the age-dependent influence of PPI-induced side effects. DESIGN and METHODS: A Markov model was developed to compare the strategy of PPI co-medication to no PPI in older LDASA users at risk of UGI side effects. As PPIs reduce the risk of UGI bleeding and dyspepsia, these risk factors were modelled together with PPI side effects for 60-69, 70-79 Ibase case) and 80 years and older LDASA users. Incremental cost-utility ratios (ICURs) were calculated as cost per quality-adjusted life year (QALY) gained per age category. Furthermore, a budget impact analysis (BIA) assessed the expected changes in expenditure of the Dutch health care system following the adoption of PPI co-treatment in all LDASA users potentially at risk of UGI side effects. RESULTS: PPI co-treatment of 70-79-year-old LDASA users, as compared to no PPI, resulted in incremental costs of €100.51 at incremental effects of 0.007 QALYs with an ICUR of €U,671/QALY. ICURs for 60-69-year-old LDASA users were €13,264/QALY and €64,121/QALY for 80 years and older patients. Initiation of PPI co-treatment for all Dutch LDASA users of 60 years and older at risk of UGI side effects but not prescribed a PPI (19%) would have cost €1.280,478 in the first year. CONCLUSION: PPI co-medication in LDASA users at risk of UGI side effects generally is cost-effective. However, this strategy becomes less cost-effective with higher age, particularly in patients aged 80 and older, mainly due to the increased risks of PPI-induced side effects.
Original languageDutch
Pages (from-to)23-30
JournalPharmaceutisch Weekblad
Volume154
Issue number24
Publication statusPublished - 2019

Cite this

Chau, Sek Hung ; Sluiter, Reinier L. ; Kievit, Wietske ; Wensing, Michel ; Teichert, Maxtina ; Hugtenburg, Jacqueline G. / De kosteneffectiviteit van maagbescherming met protonpompremmers bij gebruikers van laaggedoseerde salicylaten. In: Pharmaceutisch Weekblad. 2019 ; Vol. 154, No. 24. pp. 23-30.
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title = "De kosteneffectiviteit van maagbescherming met protonpompremmers bij gebruikers van laaggedoseerde salicylaten",
abstract = "OBJECTIVE: The present study aimed to assess the cost-effectiveness of concomitant proton pump inhibitor |PPI) treatment in low dose acetylsalicylic acid (LDASA) users at risk of upper gastrointestinal (UGI) side effects as compared to no PPI co-medication with attention to the age-dependent influence of PPI-induced side effects. DESIGN and METHODS: A Markov model was developed to compare the strategy of PPI co-medication to no PPI in older LDASA users at risk of UGI side effects. As PPIs reduce the risk of UGI bleeding and dyspepsia, these risk factors were modelled together with PPI side effects for 60-69, 70-79 Ibase case) and 80 years and older LDASA users. Incremental cost-utility ratios (ICURs) were calculated as cost per quality-adjusted life year (QALY) gained per age category. Furthermore, a budget impact analysis (BIA) assessed the expected changes in expenditure of the Dutch health care system following the adoption of PPI co-treatment in all LDASA users potentially at risk of UGI side effects. RESULTS: PPI co-treatment of 70-79-year-old LDASA users, as compared to no PPI, resulted in incremental costs of €100.51 at incremental effects of 0.007 QALYs with an ICUR of €U,671/QALY. ICURs for 60-69-year-old LDASA users were €13,264/QALY and €64,121/QALY for 80 years and older patients. Initiation of PPI co-treatment for all Dutch LDASA users of 60 years and older at risk of UGI side effects but not prescribed a PPI (19{\%}) would have cost €1.280,478 in the first year. CONCLUSION: PPI co-medication in LDASA users at risk of UGI side effects generally is cost-effective. However, this strategy becomes less cost-effective with higher age, particularly in patients aged 80 and older, mainly due to the increased risks of PPI-induced side effects.",
author = "Chau, {Sek Hung} and Sluiter, {Reinier L.} and Wietske Kievit and Michel Wensing and Maxtina Teichert and Hugtenburg, {Jacqueline G.}",
year = "2019",
language = "Dutch",
volume = "154",
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journal = "Pharmaceutisch Weekblad",
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De kosteneffectiviteit van maagbescherming met protonpompremmers bij gebruikers van laaggedoseerde salicylaten. / Chau, Sek Hung; Sluiter, Reinier L.; Kievit, Wietske; Wensing, Michel; Teichert, Maxtina; Hugtenburg, Jacqueline G.

In: Pharmaceutisch Weekblad, Vol. 154, No. 24, 2019, p. 23-30.

Research output: Contribution to journalArticleProfessional

TY - JOUR

T1 - De kosteneffectiviteit van maagbescherming met protonpompremmers bij gebruikers van laaggedoseerde salicylaten

AU - Chau, Sek Hung

AU - Sluiter, Reinier L.

AU - Kievit, Wietske

AU - Wensing, Michel

AU - Teichert, Maxtina

AU - Hugtenburg, Jacqueline G.

PY - 2019

Y1 - 2019

N2 - OBJECTIVE: The present study aimed to assess the cost-effectiveness of concomitant proton pump inhibitor |PPI) treatment in low dose acetylsalicylic acid (LDASA) users at risk of upper gastrointestinal (UGI) side effects as compared to no PPI co-medication with attention to the age-dependent influence of PPI-induced side effects. DESIGN and METHODS: A Markov model was developed to compare the strategy of PPI co-medication to no PPI in older LDASA users at risk of UGI side effects. As PPIs reduce the risk of UGI bleeding and dyspepsia, these risk factors were modelled together with PPI side effects for 60-69, 70-79 Ibase case) and 80 years and older LDASA users. Incremental cost-utility ratios (ICURs) were calculated as cost per quality-adjusted life year (QALY) gained per age category. Furthermore, a budget impact analysis (BIA) assessed the expected changes in expenditure of the Dutch health care system following the adoption of PPI co-treatment in all LDASA users potentially at risk of UGI side effects. RESULTS: PPI co-treatment of 70-79-year-old LDASA users, as compared to no PPI, resulted in incremental costs of €100.51 at incremental effects of 0.007 QALYs with an ICUR of €U,671/QALY. ICURs for 60-69-year-old LDASA users were €13,264/QALY and €64,121/QALY for 80 years and older patients. Initiation of PPI co-treatment for all Dutch LDASA users of 60 years and older at risk of UGI side effects but not prescribed a PPI (19%) would have cost €1.280,478 in the first year. CONCLUSION: PPI co-medication in LDASA users at risk of UGI side effects generally is cost-effective. However, this strategy becomes less cost-effective with higher age, particularly in patients aged 80 and older, mainly due to the increased risks of PPI-induced side effects.

AB - OBJECTIVE: The present study aimed to assess the cost-effectiveness of concomitant proton pump inhibitor |PPI) treatment in low dose acetylsalicylic acid (LDASA) users at risk of upper gastrointestinal (UGI) side effects as compared to no PPI co-medication with attention to the age-dependent influence of PPI-induced side effects. DESIGN and METHODS: A Markov model was developed to compare the strategy of PPI co-medication to no PPI in older LDASA users at risk of UGI side effects. As PPIs reduce the risk of UGI bleeding and dyspepsia, these risk factors were modelled together with PPI side effects for 60-69, 70-79 Ibase case) and 80 years and older LDASA users. Incremental cost-utility ratios (ICURs) were calculated as cost per quality-adjusted life year (QALY) gained per age category. Furthermore, a budget impact analysis (BIA) assessed the expected changes in expenditure of the Dutch health care system following the adoption of PPI co-treatment in all LDASA users potentially at risk of UGI side effects. RESULTS: PPI co-treatment of 70-79-year-old LDASA users, as compared to no PPI, resulted in incremental costs of €100.51 at incremental effects of 0.007 QALYs with an ICUR of €U,671/QALY. ICURs for 60-69-year-old LDASA users were €13,264/QALY and €64,121/QALY for 80 years and older patients. Initiation of PPI co-treatment for all Dutch LDASA users of 60 years and older at risk of UGI side effects but not prescribed a PPI (19%) would have cost €1.280,478 in the first year. CONCLUSION: PPI co-medication in LDASA users at risk of UGI side effects generally is cost-effective. However, this strategy becomes less cost-effective with higher age, particularly in patients aged 80 and older, mainly due to the increased risks of PPI-induced side effects.

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M3 - Article

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