Presentation (CTI)

OBJECTIVES: Patients with non-valvular atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs) are at increased risk of upper gastrointestinal bleeding (UGIB). Concomitant use of proton pump inhibitors (PPI) may reduce gastrointestinal complication. However, the long-term economic value of preventive PPI use remains uncertain. This study evaluated the cost-effectiveness of PPI co-therapy compared with DOAC monotherapy in patients with non-vascular AF in South Korea.
METHODS: A hybrid model combining a decision tree and a Markov model was developed from the Korean healthcare system perspective. The decision tree captured clinical events occurring during the first year, including UGIB, stroke, and stroke-related death, and the Markov model projected long-term outcomes over a lifetime horizon (28 years). PPI was assumed to be used for one year, with treatment effects assumed to occur only during the treatment period because of the lack of evidence on long-term benefits. Health outcomes were measured in life-years (LYs) and quality-adjusted life-years (QALYs). Clinical inputs were obtained from published literature, and healthcare costs were estimated using Korean nationwide health insurance claims data. Costs and outcomes were discounted at 4.5% annually.
RESULTS: Over a lifetime horizon, PPI co-therapy generated an additional 0.04 LYs and 0.05 QALYs per patient compared with DOAC monotherapy. Total lifetime costs were USD 31,733 (USD 1 = KRW 1,422; 2025 exchange rate) for PPI co-therapy and USD 31,491 for DOAC monotherapy, representing an additional cost of USD 242 per patient. The incremental cost-effectiveness ratio (ICER) was USD 4,541 per QALY gained.
CONCLUSIONS: Among patients with AF receiving DOACs, concomitant PPI therapy improves health outcomes. These findings suggest that preventive PPI use is likely to be a cost-effective strategy in the population. Future analyses incorporating trial-based evidence and longer-term treatment effects are warranted.