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Cost estimates were from a third\u2010party payer perspective. The outcomes were incremental cost per ulcer complication avoided and incremental cost per quality\u2010adjusted life year (QALY) gained. Sensitivity analysis was performed to evaluate the impact of varying patient GI risks and aspirin use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In average\u2010risk patients, the NSAID<jats:sub>NS<\/jats:sub>+ PPI strategy costs an incremental $45,350 per additional ulcer complication avoided and $309,666 per QALY gained compared with the NSAID<jats:sub>NS<\/jats:sub>strategy. The coxib strategy was less effective and more expensive than the NSAID<jats:sub>NS<\/jats:sub>+ PPI strategy. Sensitivity analysis revealed that the NSAID<jats:sub>NS<\/jats:sub>+ PPI strategy became the dominant approach in patients at high risk for an NSAID adverse event (i.e., patients taking aspirin with \u22651 risk factor for a GI complication).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Generic nonselective NSAIDs are most cost\u2010effective in patients at low risk for an adverse event. 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