PMID- 16844422
OWN - NLM
STAT- MEDLINE
DCOM- 20061109
LR  - 20131121
IS  - 1542-3565 (Print)
IS  - 1542-3565 (Linking)
VI  - 4
IP  - 8
DP  - 2006 Aug
TI  - The cost-effectiveness and budget impact of intravenous versus oral proton pump 
      inhibitors in peptic ulcer hemorrhage.
PG  - 988-997
AB  - BACKGROUND & AIMS: The most cost-effective route of administering proton pump 
      inhibitor (PPI) therapy in peptic ulcer hemorrhage remains uncertain. Oral (PO) 
      PPI therapy may be less effective than intravenous (IV) PPI therapy, but is less 
      expensive and does not mandate a 72-hour posthemostasis hospital stay to complete 
      a full therapeutic course. Because there are currently no published head-to-head 
      clinical trials comparing IV vs PO PPIs, we used decision analysis with budget 
      impact modeling to measure the clinical and economic outcomes of these competing 
      modes of administration. METHODS: We compared 3 postendoscopic strategies for 
      high-risk peptic ulcer hemorrhage: (1) PO PPI therapy, (2) IV PPI therapy, and 
      (3) IV histamine(2) receptor antagonist therapy. The primary outcomes were cost 
      per quality-adjusted life-year gained, and per-member per-month cost in a 
      hypothetical managed care organization with 1,000,000 covered lives. RESULTS: 
      Compared with the PPI strategies, the histamine(2) receptor antagonist strategy 
      was more expensive and less effective. Of the 2 PPI strategies, using IV instead 
      of PO PPI cost an incremental 708,735 US dollars per year to gain 1 additional 
      quality-adjusted life-year. Substituting IV in lieu of PO PPI cost each member 
      2.86 US dollars per month to subsidize. The IV PPI strategy became dominant when 
      the rebleed rate with PO PPIs exceeded 24% (base case = 13%), and when the 
      hospital stay on IV PPIs decreased to less than 72 hours. CONCLUSIONS: The higher 
      effectiveness of IV PPI therapy may not offset its increased costs vs PO PPI 
      therapy in ulcer hemorrhage. The managed care budget impact of IV PPIs exceeds 
      most benchmarks.
FAU - Spiegel, Brennan M R
AU  - Spiegel BM
AD  - Division of Gastroenterology, Veteran's Administration Greater Los Angeles 
      Healthcare System, California, USA.
FAU - Dulai, Gareth S
AU  - Dulai GS
FAU - Lim, Brian S
AU  - Lim BS
FAU - Mann, Neel
AU  - Mann N
FAU - Kanwal, Fasiha
AU  - Kanwal F
FAU - Gralnek, Ian M
AU  - Gralnek IM
LA  - eng
GR  - K23 RR-16188/RR/NCRR NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20060717
PL  - United States
TA  - Clin Gastroenterol Hepatol
JT  - Clinical gastroenterology and hepatology : the official clinical practice journal 
      of the American Gastroenterological Association
JID - 101160775
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Administration, Oral
MH  - Anti-Ulcer Agents/*administration & dosage/*economics
MH  - Cost-Benefit Analysis
MH  - Decision Trees
MH  - Endoscopy, Gastrointestinal
MH  - Humans
MH  - Infusions, Intravenous
MH  - Length of Stay/economics
MH  - Models, Economic
MH  - Monte Carlo Method
MH  - Peptic Ulcer Hemorrhage/*drug therapy/*economics
MH  - *Proton Pump Inhibitors
MH  - Quality-Adjusted Life Years
MH  - Recurrence
EDAT- 2006/07/18 09:00
MHDA- 2006/11/11 09:00
CRDT- 2006/07/18 09:00
PHST- 2006/07/18 09:00 [pubmed]
PHST- 2006/11/11 09:00 [medline]
PHST- 2006/07/18 09:00 [entrez]
AID - S1542-3565(06)00488-5 [pii]
AID - 10.1016/j.cgh.2006.05.019 [doi]
PST - ppublish
SO  - Clin Gastroenterol Hepatol. 2006 Aug;4(8):988-997. doi: 
      10.1016/j.cgh.2006.05.019. Epub 2006 Jul 17.