PMID- 18407271
OWN - NLM
STAT- MEDLINE
DCOM- 20080825
LR  - 20131121
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 67
IP  - 7
DP  - 2008 Jun
TI  - Cost-effectiveness analysis of high-dose omeprazole infusion before endoscopy for 
      patients with upper-GI bleeding.
PG  - 1056-63
LID - 10.1016/j.gie.2007.11.056 [doi]
AB  - BACKGROUND: The use of intravenous (i.v.) proton pump inhibitors (PPI) before an 
      endoscopy in upper-GI bleeding (UGIB) was shown to reduce the need of endoscopic 
      therapy and shorten hospital stay. OBJECTIVE: To investigate whether preemptive 
      use of a PPI in UGIB is a cost-effective strategy. DESIGN: A decision analysis 
      model that represents treatment pathways for patients with UGIB was constructed 
      and structuralized by 30-day outcomes. Direct costs of medical treatment, 
      diagnostic and therapeutic endoscopy, endoscopic re-treatment, surgery, and 
      hospitalization were analyzed. SETTING: Prince of Wales Hospital, Hong Kong. 
      PATIENTS: A total of 631 patients were recruited. Sixty patients (19.1%) in the 
      PPI group and 90 patients (28.4%) in the placebo group required endoscopic 
      hemostasis at index endoscopy. MAIN OUTCOME MEASUREMENTS: The primary 
      measurements were cost-effectiveness ratios and incremental cost-effectiveness 
      ratios (ICER) to avert endoscopic therapy between PPI and placebo treatment. 
      Sensitivity analyses were conducted by varying the cost of endoscopy, 
      hospitalization, the incidence rate of endoscopic therapy, and the proportion of 
      bleeding peptic ulcers. RESULTS: The overall direct cost per patient was U.S. 
      dollars (USD) $2813 for PPI treatment and USD $2948 for the placebo. A PPI 
      reduced endoscopic therapy by 7.4% and resulted in a lower cost-effectiveness 
      ratio per endoscopic therapy averted (USD $3561) than the placebo (USD $4117). 
      The ICER value was USD -$1843, which indicated that preemptive PPI treatment is 
      more effective and less costly for UGIB. When the proportions of patients with 
      peptic ulcer bleeding were greater than 8.3%, the preemptive PPI treatment 
      remained cost saving. CONCLUSIONS: Preemptive use of IV PPI before an endoscopy 
      is a cost-effective strategy in the management of UGIB.
FAU - Tsoi, Kelvin K F
AU  - Tsoi KK
AD  - Institute of Digestive Disease, the Chinese University of Hong Kong, Shatin, Hong 
      Kong SAR, China.
FAU - Lau, James Y W
AU  - Lau JY
FAU - Sung, Joseph J Y
AU  - Sung JJ
LA  - eng
SI  - ClinicalTrials.gov/NCT00164866
PT  - Comparative Study
PT  - Journal Article
DEP - 20080414
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
RN  - KG60484QX9 (Omeprazole)
SB  - IM
CIN - Gastrointest Endosc. 2008 Jun;67(7):1064-6. PMID: 18513549
MH  - Adult
MH  - Aged
MH  - Cohort Studies
MH  - Cost Savings
MH  - Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Endoscopy, Gastrointestinal/economics/methods
MH  - Female
MH  - Gastrointestinal Hemorrhage/diagnosis/*economics/*therapy
MH  - Hemostasis, Endoscopic/economics/methods
MH  - Hong Kong
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Omeprazole/*administration & dosage/*economics
MH  - Probability
MH  - Reference Values
MH  - Risk Assessment
MH  - Treatment Outcome
MH  - *Upper Gastrointestinal Tract
EDAT- 2008/04/15 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/04/15 09:00
PHST- 2007/07/13 00:00 [received]
PHST- 2007/11/29 00:00 [accepted]
PHST- 2008/04/15 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/04/15 09:00 [entrez]
AID - S0016-5107(07)03199-9 [pii]
AID - 10.1016/j.gie.2007.11.056 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2008 Jun;67(7):1056-63. doi: 10.1016/j.gie.2007.11.056. Epub 
      2008 Apr 14.