PMID- 12859587
OWN - NLM
STAT- MEDLINE
DCOM- 20030908
LR  - 20131121
IS  - 1098-3015 (Print)
IS  - 1098-3015 (Linking)
VI  - 6
IP  - 4
DP  - 2003 Jul-Aug
TI  - Cost implications of administering intravenous proton pump inhibitors to all 
      patients presenting to the emergency department with peptic ulcer bleeding.
PG  - 457-65
AB  - OBJECTIVES: Administering proton pump inhibitors (PPI) intravenously (iv) after 
      endoscopic treatment of bleeding peptic ulcers reduces the incidence of 
      rebleeding, the need for operative procedures, and hospitalizations. We assessed 
      the cost implications of iv PPI initiated in all patients presenting to the 
      emergency department (ED) with signs of upper gastrointestinal (UGI) bleeding. 
      METHODS: From a third-party payer perspective with a time horizon of 60 days, we 
      built a decision analytic model comparing standard endoscopic therapy to a 
      strategy in which all patients presenting to the ED with UGI bleeding would start 
      iv PPI before endoscopy. After endoscopy, only those with peptic ulcers would be 
      kept on iv PPI added to standard therapy. Probabilities of health events were 
      extracted from published literature. Resource utilization profiles and costs (iv 
      PPI, hospital stay for medical and operative procedures, and professional fees) 
      were based on Medicare reimbursement data from a large hospital in Alabama. All 
      costs were expressed in 2000 US dollars. Uncertainty was investigated through 
      one-way sensitivity analyses and probabilistic analyses using Monte Carlo 
      simulations. RESULTS: In a hypothetical group of 1000 individuals, routine use of 
      iv PPI prevented 40 rebleeds, 9 surgical procedures, and 223 hospital days, and 
      led to incremental savings of dollars 920 per subject. Probabilistic sensitivity 
      analyses indicated that the strategy of using iv PPI was likely to be dominant 
      even when accounting for uncertainty. CONCLUSIONS: Based on available evidence, 
      routine administration of iv PPI to all persons presenting with UGI bleeding 
      represents good value for money and merits consideration as standard hospital 
      policy.
FAU - Gagnon, Yves M
AU  - Gagnon YM
AD  - Occam Research & Consulting Inc, Vancouver, British Columbia, Canada.
FAU - Levy, Adrian R
AU  - Levy AR
FAU - Eloubeidi, Mohamad A
AU  - Eloubeidi MA
FAU - Arguedas, Miguel R
AU  - Arguedas MR
FAU - Rioux, Kevin P
AU  - Rioux KP
FAU - Enns, Robert A
AU  - Enns RA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Value Health
JT  - Value in health : the journal of the International Society for Pharmacoeconomics 
      and Outcomes Research
JID - 100883818
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Anti-Ulcer Agents/*economics/*therapeutic use
MH  - Costs and Cost Analysis
MH  - Drug Costs
MH  - Emergency Service, Hospital/*economics
MH  - Female
MH  - *Hospital Costs
MH  - Humans
MH  - Infusions, Intravenous
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Monte Carlo Method
MH  - Peptic Ulcer Hemorrhage/*drug therapy/economics
MH  - *Proton Pump Inhibitors
MH  - Treatment Outcome
MH  - United States
EDAT- 2003/07/16 05:00
MHDA- 2003/09/10 05:00
CRDT- 2003/07/16 05:00
PHST- 2003/07/16 05:00 [pubmed]
PHST- 2003/09/10 05:00 [medline]
PHST- 2003/07/16 05:00 [entrez]
AID - S1098-3015(10)60157-X [pii]
AID - 10.1046/j.1524-4733.2003.64262.x [doi]
PST - ppublish
SO  - Value Health. 2003 Jul-Aug;6(4):457-65. doi: 10.1046/j.1524-4733.2003.64262.x.