PMID- 20096378
OWN - NLM
STAT- MEDLINE
DCOM- 20100607
LR  - 20100329
IS  - 1542-7714 (Electronic)
IS  - 1542-3565 (Linking)
VI  - 8
IP  - 4
DP  - 2010 Apr
TI  - Reduced hospitalization cost for upper gastrointestinal events that occur among 
      elderly veterans who are gastroprotected.
PG  - 350-6; quiz e45
LID - 10.1016/j.cgh.2010.01.002 [doi]
AB  - BACKGROUND & AIMS: Despite prescription of gastroprotection among elderly 
      nonsteroidal anti-inflammatory drug (NSAID) users, residual bleeding can still 
      occur. We sought to determine the effect of proton pump inhibitors (PPI) on 
      hospitalization and resource use among veterans in whom an upper gastrointestinal 
      event (UGIE) occurred. METHODS: We identified from national pharmacy records 
      veterans > or =65 years prescribed an NSAID, cyclooxygenase-2 selective NSAID 
      (coxib), or salicylate (>325 mg/day) at any Veterans Affairs (VA) facility 
      (01/01/00-12/31/04). Prescription fill data were linked longitudinally to a 
      Veterans Affairs-Medicare dataset of inpatient, outpatient, and death files, and 
      demographic and provider data. Among veterans in whom a UGIE occurred, we 
      assessed the effect of prescription strategy on hospitalization, using a 
      multivariate logistic regression model. RESULTS: A total of 3566 UGIEs occurred 
      among a cohort that was predominantly male (97.5%), white (77%), with a mean age 
      of 73.5 (SD, 5.7). Hospitalization occurred in 47.5%, and gastroprotection was 
      associated with a 30% reduction in hospitalization compared with no PPI. 
      Five-year pharmacy costs associated with the PPI strategy exceeded the no-PPI 
      strategy ($742,406 vs $184,282); however, a substantial reduction in medical 
      costs was observed with PPI ($9,948,738 vs $18,686,081). CONCLUSIONS: Even if an 
      NSAID-UGIE occurs in the PPI-protected older veteran, the reduction in need for 
      hospitalization results in a cost saving to the Department of Veterans Affairs.
CI  - Copyright 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.
FAU - Abraham, Neena S
AU  - Abraham NS
AD  - Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey 
      Veterans Affairs Medical Center, Houston, Texas 77030, USA. nabraham@bcm.edu
FAU - Hartman, Christine
AU  - Hartman C
FAU - Hasche, Jennifer
AU  - Hasche J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20100121
PL  - United States
TA  - Clin Gastroenterol Hepatol
JT  - Clinical gastroenterology and hepatology : the official clinical practice journal 
      of the American Gastroenterological Association
JID - 101160775
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Cyclooxygenase 2 Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Salicylates)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/*therapeutic use
MH  - Cyclooxygenase 2 Inhibitors/adverse effects/therapeutic use
MH  - Female
MH  - Gastrointestinal Hemorrhage/*chemically induced/pathology/*prevention & control
MH  - *Health Care Costs
MH  - Hospitalization/*economics
MH  - Humans
MH  - Male
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Salicylates/adverse effects/therapeutic use
MH  - Veterans
EDAT- 2010/01/26 06:00
MHDA- 2010/06/09 06:00
CRDT- 2010/01/26 06:00
PHST- 2009/10/09 00:00 [received]
PHST- 2009/12/11 00:00 [revised]
PHST- 2010/01/12 00:00 [accepted]
PHST- 2010/01/26 06:00 [entrez]
PHST- 2010/01/26 06:00 [pubmed]
PHST- 2010/06/09 06:00 [medline]
AID - S1542-3565(10)00042-X [pii]
AID - 10.1016/j.cgh.2010.01.002 [doi]
PST - ppublish
SO  - Clin Gastroenterol Hepatol. 2010 Apr;8(4):350-6; quiz e45. doi: 
      10.1016/j.cgh.2010.01.002. Epub 2010 Jan 21.