Several articles in the May 27 issue of the ARCHIVES helped to clarify some of the clinical issues regarding the risk of cardiovascular events in patients treated with COX-2 inhibitors. The editorial by Dalen1 noted that many users of NSAIDs and COX-2 inhibitors are in the age group that has or is at risk of having coronary artery disease and suggested that "the concomitant use of low-dose aspirin (80 mg/d) should be strongly considered in patients with a history of coronary artery disease, stroke, transient ischemic attack, or peripheral vascular disease." In our respectful opinion, the concomitant use of aspirin and COX-2 inhibitors may not represent the most cost-effective approach to patient treatment. The addition of aspirin to a COX-2 inhibitor regimen changes the balance of incremental costs and benefits of COX-2 inhibitors over standard NSAID therapy.
Pickard AS, Schumock GT. Aspirin Use May Change Cost-effectiveness of COX-2 Inhibitors. Arch Intern Med. 2002;162(22):2637. doi: