Cost-Benefit of PPI Gastroprotection among Elderly NSAID Users
Bibliographic record
Abstract
Purpose: Our aim was to quantify national cost-benefit of proton pump inhibitor (PPI) gastroprotection in a cohort of elderly NSAID users. Methods: Veterans ≥ 65 years prescribed an NSAID or coxib at a VA facility (01/01/00–12/31/02) were identified from national prescription fill data and records linked to VA and Medicare inpatient, outpatient and death files. Using our published algorithm, we defined UGIE and assessed related endoscopic, radiological or surgical procedures, ambulatory visits and inpatient hospitalization days. The VA National Average Cost Dataset was used to assess healthcare utilization costs, apportioned as recommended by published methodology. Pharmacy costs, from the VA Pharmacy Benefits Management program, were considered cumulative from the index NSAID prescription to the UGIE. Each person-day of follow-up was assessed for exposure to NSAID, coxib and overlapping PPI. Regression models assessed whether PPI gastroprotection resulted in reduced healthcare use, while adjusting for demographics; UGIE risk factors; co-morbidity; prescription channeling (i.e., propensity score); geographic location and multiple time-dependent pharmacological covariates, including aspirin, anticoagulants, antiplatelets and statins. Results: In 481,495 veterans, 3,205 UGIE (97.3% male; 78.6% white; mean age, 73.9 [SD 5.7]), occurred in 293,594 person-years of follow-up. Of these UGIE, 36.9% were treated by the VA (i.e., VA-UGIE), costing $5.05 million, 97% of which ($4.9 million) was related to medical resource use and $150,000 to pharmacy costs. Of VA-UGIE patients, 50% were hospitalized; the 33.8% prescribed a PPI were less likely to be hospitalized (OR 0.39; 95% CI: 0.30–0.52) and had a lower median total medical cost than those not prescribed a PPI ($522.14 [IQR 1935] vs. $1,268.91 [IQR 4176]; P < 0.001). PPI prophylaxis for an NSAID-related UGIE requires an additional $234 per veteran. However, this increase is offset by a $2,019 reduction in total medical costs per veteran. Conclusion: PPI gastroprotection for high-risk elderly patients is associated with fewer NSAID-related UGIE and reduced hospitalization and associated resource costs. Reduced resource costs offset higher pharmacy-related costs, making PPI gastroprotection beneficial for elderly veterans.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".