The cost‐effectiveness of high‐dose oral proton pump inhibition after endoscopy in the acute treatment of peptic ulcer bleeding

• Published in: Alimentary pharmacology & therapeutics 2004-07, Vol.20 (2), p.195-202
• Main Authors: Barkun, A. N., Herba, K., Adam, V., Kennedy, W., Fallone, C. A., Bardou, M.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cost-Benefit Analysis; Digestive system; Endoscopy, Gastrointestinal; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Length of Stay; Medical sciences; Models, Economic; Peptic Ulcer Hemorrhage - drug therapy; Peptic Ulcer Hemorrhage - economics; Pharmacology. Drug treatments; Proton Pump Inhibitors; Randomized Controlled Trials as Topic
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2004.02035.x

Summary Background : Recent data suggest a role for high‐dose oral proton pump inhibition in ulcer bleeding. Aim : To compare the cost‐effectiveness of oral high‐dose proton pump inhibition to both high‐dose intravenous proton pump inhibition and placebo administration. Methods : The model adopted a 30‐day time horizon, and focused on patients with ulcer haemorrhage initially treated endoscopically for high‐risk stigmata. Re‐bleeding rates were set a priori based on non‐head‐to‐head data from the literature, and charges and lengths of stay from a national American database. Sensitivity analyses were carried across a broad range of clinically relevant assumptions. Results : Re‐bleeding rates for patients receiving intravenous, oral, or placebo therapies were 5.9%, 11.8%, and 27%, respectively. The mean lengths of stay and costs for admitted patients with and without re‐bleeding were 4.7 and 3 days; $11 802, and $7993, respectively. High‐dose intravenous proton pump inhibition was more effective and less costly (dominant) than high‐dose oral proton pump inhibition with incremental savings of $136.40 per patient treated. The oral high‐dose strategy in turn dominated placebo administration. Results remained robust according to one‐ and two‐way sensitivity analyses. Conclusion : In patients undergoing endoscopic haemostasis, subsequent high‐dose intravenous proton pump inhibition is more cost‐effective than high‐dose oral proton pump inhibition, which in turn dominates placebo. The results from this exploratory‐type cost analysis require confirmation by head‐to‐head prospective trials performed in Western populations.