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Saini et al used a Markov model to estimate the effectiveness and cost-effectiveness of routinely adding a PPI for older adults with coronary heart disease who are taking ASA for secondary prevention. They assumed that PPI use would reduce the incidence of UGIB by 66%, based on the results of 2 previous small randomized trials1,2 in higher-risk Asian patients who received a prescription PPI to prevent recurrent ulcer-related bleeding. They also assumed that the PPI would have no major adverse effects itself and would have an annual cost of $250. They did not examine changes in quality of life, based on the assumption that any decrement in quality of life from UGIB would be short-lived. They also did not incorporate any adverse effects associated with taking an additional pill daily, which can have important effects when considering preventive therapies,3,4 or any benefits from reduction in dyspepsia.
Pignone M. Cost-effectiveness of Proton Pump Inhibitor Cotherapy in Patients Taking Long-term, Low-Dose Aspirin for Secondary Cardiovascular Prevention—Invited Commentary. Arch Intern Med. 2008;168(15):1691. doi:10.1001/archinte.168.15.1691