PMID- 15187506
OWN - NLM
STAT- MEDLINE
DCOM- 20040716
LR  - 20190706
IS  - 0090-3493 (Print)
IS  - 0090-3493 (Linking)
VI  - 32
IP  - 6
DP  - 2004 Jun
TI  - Cost-effectiveness of proton pump inhibitor therapy for acute peptic 
      ulcer-related bleeding.
PG  - 1277-83
AB  - OBJECTIVE: The purpose of this investigation was to perform a cost-effectiveness 
      analysis of adjunctive oral and intravenous proton pump inhibitor (PPI) therapies 
      for patients with acute peptic ulcer-related bleeding of sufficient severity to 
      warrant hospitalization. DESIGN: Cost-effectiveness investigation. Four clinical 
      scenarios were considered: scenario 1, diagnostic endoscopy with oral PPI 
      therapy; scenario 2, diagnostic and therapeutic endoscopy with high-dose 
      intravenous PPI therapy; scenario 3, diagnostic and therapeutic endoscopy 
      available with oral PPI therapy; and scenario 4, diagnostic and therapeutic 
      endoscopy (no PPI). Effectiveness was evaluated in terms of episodes of bleeding 
      averted and quality-adjusted life years. SETTING: University teaching hospital in 
      the United States. PATIENTS: Hospitalized patients with acute peptic ulcer 
      bleeding. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Therapeutic 
      endoscopy with high-dose intravenous PPI therapy (scenario 2) was the most 
      cost-effective approach in terms of bleeding episode averted (8,490 vs. 10,201 US 
      dollars for scenario 1, 8,756 US dollars for scenario 3, and 12,459 US dollars 
      for scenario 4) and per quality-adjusted life year (4,810 vs. 5,533 US dollars 
      for scenario 1, 4,946 US dollars for scenario 3, and 5,876 US dollars for 
      scenario 4). The high-dose intravenous PPI scenario was the dominant approach as 
      evidenced by both superior effectiveness and lower costs over the range of 
      probability and cost variables used in the sensitivity analysis. However, the 
      dominance would be lost if the purchase cost of the intravenous PPI was 
      substantially higher than the baseline cost assumed in this investigation (61 US 
      dollars per 3-day course of therapy). CONCLUSION: High-dose intravenous PPI 
      therapy in conjunction with therapeutic endoscopy is the most cost-effective 
      approach for the management of hospitalized patients with acute peptic ulcer 
      bleeding.
FAU - Erstad, Brian L
AU  - Erstad BL
AD  - Department of Pharmacy Practice & Science, College of Pharmacy, University of 
      Arizona, Tucson, 85721-0207, USA. erstad@pharmacy.arizona.edu
LA  - eng
GR  - 5 K30 HL004519/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Crit Care Med
JT  - Critical care medicine
JID - 0355501
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - Crit Care Med. 2004 Jun;32(6):1415-6. PMID: 15187531
MH  - Acute Disease
MH  - Administration, Oral
MH  - Cost-Benefit Analysis
MH  - Endoscopy, Gastrointestinal
MH  - Hospitalization
MH  - Humans
MH  - Peptic Ulcer Hemorrhage/*drug therapy/surgery
MH  - *Proton Pump Inhibitors
EDAT- 2004/06/10 05:00
MHDA- 2004/07/17 05:00
CRDT- 2004/06/10 05:00
PHST- 2004/06/10 05:00 [pubmed]
PHST- 2004/07/17 05:00 [medline]
PHST- 2004/06/10 05:00 [entrez]
AID - 00003246-200406000-00006 [pii]
AID - 10.1097/01.ccm.0000127261.09066.6e [doi]
PST - ppublish
SO  - Crit Care Med. 2004 Jun;32(6):1277-83. doi: 10.1097/01.ccm.0000127261.09066.6e.