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Michael Pignone, MD, MPH

Arch Intern Med. 2008;168(15):1691.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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 trials^1-2 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.

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Cost-effectiveness of Proton Pump Inhibitor Cotherapy in Patients Taking Long-term, Low-Dose Aspirin for Secondary Cardiovascular Prevention
Sameer D. Saini, Philip Schoenfeld, A. Mark Fendrick, and James Scheiman
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