Costs of bleeding on long-term antiplatelet treatment without routine co-prescription of proton-pump inhibitors
<p><strong>Background:</strong><br /> Long-term antiplatelet treatment is associated with major bleeding.</p><br /> <p><strong>Aims:</strong><br /> To determine the costs associated with major bleeding in patients treated with aspirin-base...
| Autori principali: | , , |
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| Natura: | Journal article |
| Lingua: | English |
| Pubblicazione: |
SAGE Publications
2019
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| _version_ | 1826281412487020544 |
|---|---|
| author | Luengo-Fernandez, R Li, L Rothwell, PM |
| author_facet | Luengo-Fernandez, R Li, L Rothwell, PM |
| author_sort | Luengo-Fernandez, R |
| collection | OXFORD |
| description | <p><strong>Background:</strong><br />
Long-term antiplatelet treatment is associated with major bleeding.</p><br />
<p><strong>Aims:</strong><br />
To determine the costs associated with major bleeding in patients treated with aspirin-based antiplatelet treatment for secondary prevention of vascular events without routine prescription of proton-pump inhibitors and to estimate the likely long-term savings from routine co-prescription.</p><br />
<p><strong>Methods:</strong><br />
In a prospective population-based cohort study of TIA, ischemic stroke, and MI treated with antiplatelet drugs, we evaluated hospital care costs associated with bleed management during 10-year follow-up. Bleeding-associated costs were averaged across all patients. For upper GI-bleeds, mean costs were compared with the cost of routine co-prescription of proton-pump inhibitor.</p><br />
<p><strong>Results:</strong><br />
Among 3166 patients on antiplatelet therapy with 405 first bleeding events, the average cost of major bleeding was $13,093 (S.D. 20,501), with similar costs for upper GI bleeds and intracranial bleeds (p = 0.235). However, total costs among the 3166 patients were higher for upper GI bleeds ($1,158,385 vs. $740,123). Averaged across all patients, the 10-year cost of major bleeding was $838 (95%CI: 680–1007), $411 due to upper GI bleeding, the cost of which increased from $175 in those aged <75 years to $644 at age ≥75 years (p < 0.0001). The corresponding costs of routine life-long co-prescription of proton-pump inhibitor to those patients not on prior treatment were $85 (84–88) and $39 (38–42).</p><br />
<p><strong>Conclusions:</strong><br />
In secondary prevention with aspirin-based antiplatelet treatment without routine proton-pump inhibitor use, the long-term costs of upper-GI bleeding at age ≥75 years are much higher than at younger age groups, and are at least 10-fold greater than the drug cost of routine co-prescription of proton-pump inhibitor.</p><br /> |
| first_indexed | 2024-03-07T00:28:25Z |
| format | Journal article |
| id | oxford-uuid:7eedf8db-a598-4741-89b2-b5e9b5d5d2b3 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T00:28:25Z |
| publishDate | 2019 |
| publisher | SAGE Publications |
| record_format | dspace |
| spelling | oxford-uuid:7eedf8db-a598-4741-89b2-b5e9b5d5d2b32022-03-26T21:13:26ZCosts of bleeding on long-term antiplatelet treatment without routine co-prescription of proton-pump inhibitorsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:7eedf8db-a598-4741-89b2-b5e9b5d5d2b3EnglishSymplectic Elements at OxfordSAGE Publications2019Luengo-Fernandez, RLi, LRothwell, PM<p><strong>Background:</strong><br /> Long-term antiplatelet treatment is associated with major bleeding.</p><br /> <p><strong>Aims:</strong><br /> To determine the costs associated with major bleeding in patients treated with aspirin-based antiplatelet treatment for secondary prevention of vascular events without routine prescription of proton-pump inhibitors and to estimate the likely long-term savings from routine co-prescription.</p><br /> <p><strong>Methods:</strong><br /> In a prospective population-based cohort study of TIA, ischemic stroke, and MI treated with antiplatelet drugs, we evaluated hospital care costs associated with bleed management during 10-year follow-up. Bleeding-associated costs were averaged across all patients. For upper GI-bleeds, mean costs were compared with the cost of routine co-prescription of proton-pump inhibitor.</p><br /> <p><strong>Results:</strong><br /> Among 3166 patients on antiplatelet therapy with 405 first bleeding events, the average cost of major bleeding was $13,093 (S.D. 20,501), with similar costs for upper GI bleeds and intracranial bleeds (p = 0.235). However, total costs among the 3166 patients were higher for upper GI bleeds ($1,158,385 vs. $740,123). Averaged across all patients, the 10-year cost of major bleeding was $838 (95%CI: 680–1007), $411 due to upper GI bleeding, the cost of which increased from $175 in those aged <75 years to $644 at age ≥75 years (p < 0.0001). The corresponding costs of routine life-long co-prescription of proton-pump inhibitor to those patients not on prior treatment were $85 (84–88) and $39 (38–42).</p><br /> <p><strong>Conclusions:</strong><br /> In secondary prevention with aspirin-based antiplatelet treatment without routine proton-pump inhibitor use, the long-term costs of upper-GI bleeding at age ≥75 years are much higher than at younger age groups, and are at least 10-fold greater than the drug cost of routine co-prescription of proton-pump inhibitor.</p><br /> |
| spellingShingle | Luengo-Fernandez, R Li, L Rothwell, PM Costs of bleeding on long-term antiplatelet treatment without routine co-prescription of proton-pump inhibitors |
| title | Costs of bleeding on long-term antiplatelet treatment without routine co-prescription of proton-pump inhibitors |
| title_full | Costs of bleeding on long-term antiplatelet treatment without routine co-prescription of proton-pump inhibitors |
| title_fullStr | Costs of bleeding on long-term antiplatelet treatment without routine co-prescription of proton-pump inhibitors |
| title_full_unstemmed | Costs of bleeding on long-term antiplatelet treatment without routine co-prescription of proton-pump inhibitors |
| title_short | Costs of bleeding on long-term antiplatelet treatment without routine co-prescription of proton-pump inhibitors |
| title_sort | costs of bleeding on long term antiplatelet treatment without routine co prescription of proton pump inhibitors |
| work_keys_str_mv | AT luengofernandezr costsofbleedingonlongtermantiplatelettreatmentwithoutroutinecoprescriptionofprotonpumpinhibitors AT lil costsofbleedingonlongtermantiplatelettreatmentwithoutroutinecoprescriptionofprotonpumpinhibitors AT rothwellpm costsofbleedingonlongtermantiplatelettreatmentwithoutroutinecoprescriptionofprotonpumpinhibitors |