Aspirin is a central part of acute hospital treatment protocols for patients with myocardial infarction (MI) or stroke. Full dose immediate-release aspirin (325 mg) is most often used in order to achieve fast platelet inhibition, however, such use carries significant risk for gastrointestinal toxicity and bleeding (GIB). In this hospital budget impact analysis, we quantified the anticipated savings from utilizing a theoretical aspirin formulation with a decreased risk of GIB relative to immediate-release aspirin.
Using inputs derived from the Nationwide Inpatient Sample and published literature, we developed a model quantifying the 1-year budget spend for aspirin and in-hospital GIB. The model simulated the impact of a switch to an aspirin with less GI toxicity, but at a higher cost. For acute MI and stroke, we presumed a length of stay of 6 days, daily cost of $0.01 for 325 mg immediate-release aspirin and $1.00 for the GI safer aspirin. We calculated the budget impact assuming the GI safer aspirin would reduce GIB rates between 0%-70% relative to immediate-release aspirin.
For a 500-bed hospital, we estimated that 870 patients were hospitalized annually for acute MI or stroke. We estimated 9.14 cases of GIB per 870 patients (1.05%) with immediate-release aspirin resulting in an estimate GIB-related costs of $129,000. The incremental cost of the $1.00 GI safer aspirin was offset by as low as a 4.01% relative risk reduction to 8.77 cases of GIB per 870 patients (1.0%). With an estimated reduction of 70% in GIB, the GI safer aspirin resulted in hospital savings as high as $97.84 per treated patient.
A theoretical aspirin formulation with a safer GI profile can result in significant cost savings for hospitals. From the formulations available on the market today, none has proven to have lower GIB risk compared to immediate-release aspirin.
© 2019 Published by Elsevier Inc.