Cost‐Effectiveness of Histamine<sub>2</sub>Receptor Antagonists Versus Proton Pump Inhibitors for Stress Ulcer Prophylaxis in Critically Ill Patients

Hammond, Drayton A.; Kathe, Niranjan; Shah, Anuj; Martin, Bradley C.

doi:10.1002/phar.1859

Cited by 28 publications

(25 citation statements)

References 40 publications

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“…Only in the meta‐analysis scenario were PPIs favored both in terms of cost savings ($688) and absolute survival benefit (1.2%). A conservative estimate for CA with stress ulcer prophylaxis initiation is the difference in major upper gastrointestinal bleeding (2.4%) times the cost savings with an H 2 RA, which was $53 in 2015 U.S. dollars . Similar results were found in another cost‐effectiveness analysis .…”

Section: Results Of Scoping Reviewsupporting

confidence: 62%

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

et al. 2019

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A framework for evaluating pharmacists’ impact on cost avoidance in the intensive care unit (ICU) and emergency department (ED) has not been established. This scoping review was registered (CRD42018091217) and conducted to identify, aggregate, and qualitatively describe the highest quality evidence for cost avoidance generated by clinical pharmacists on interventions performed in an ICU or ED. Searches were conducted in PubMed, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception until April 2018. The level of evidence (LOE) for each specific category of intervention was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation evidence‐to‐decision framework. The risks of bias for articles were evaluated using Newcastle Ottawa and Cochrane Collaboration tools. The values from all interventions were inflated to 2018 U.S. dollars using the consumer price index for medical care. Of the 464 articles initially identified, 371 were excluded and 93 were included. After reviewing references from the articles included, an additional 71 articles were also reviewed. The 38 cost intervention categories were supported by varying LOEs: IA (0 categories), IB (1 category), IIA (4 categories), IIB (0 categories), III (27 categories), and IV (6 categories), and articles mostly displayed low to moderate risks of bias. Pharmacists generate cost avoidance through a variety of interventions in critically and emergently ill patients. The quality of evidence supporting specific cost avoidance values is generally low. Quantification of and factors associated with the cost avoidance generated from pharmacists caring for these patients are of paramount importance.

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Section: Results Of Scoping Reviewsupporting

confidence: 62%

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

et al. 2019

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“…Bleeding in ACS patients has been consistently linked with a worse prognosis, including a 60% increase in mortality when major bleeding has occurred [28]. PPIs, being recognized as powerful gastroprotective agents, are typically selected as the agents of choice to prevent adverse GI complications [6][7][8]; however, their association with multiple adverse events and the suggestion that they may lessen the benefits of clopidogrel have raised concerns. Thus, we set out to compare the efficacy (reduction in GI complications) and safety (MACE risk) of 2 gastroprotective regimens, namely, PPIs and H2RAs.…”

Section: Discussionmentioning

confidence: 99%

“…The incremental benefit and cost effectiveness of PPIs have therefore been questioned when compared to other gastric acid suppressants, particularly Histamine 2 receptor antagonists (H2RAs) [8]. Prior observational studies have suggested that H2RAs are associated with a lower risk of rehospitalization post-ACS and of target vessel revascularization [4], possibly because H2RAs allow for greater platelet inhibition [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

H2 Receptor Antagonists versus Proton Pump Inhibitors in Patients on Dual Antiplatelet Therapy for Coronary Artery Disease: A Systematic Review

Almufleh¹,

Ramirez²,

So³

et al. 2018

Cardiology

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Objectives: Mitigating the gastrointestinal (GI) bleeding risks of dual antiplatelet therapy (DAPT) is a common clinical concern. While proton pump inhibitors (PPIs) remain the most effective therapy, their adverse events warrant considering alternatives, including Histamine 2 receptor antagonists (H2RAs). Methods: We searched for randomized controlled trials in MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials, published from 1980 to 2016. After screening, 10 trials were eligible. We compared PPIs to H2RAs in patients on DAPT in terms of 2 clinical and one laboratory outcomes; GI complications, major adverse cardiovascular events (MACE) and high on-treatment platelet reactivity (HTPR). Clinical and statistical inter-study heterogeneity was low for all 3 outcomes (I² = 0%, p > 0.05 for all). Results: Fixed effects meta-analysis suggested that PPIs were superior to H2RAs in preventing GI complications (OR 0.28, 95% CI 0.17–0.48) but with higher risk of HTPR (OR 1.28, 95% CI 1.030–1.60) though without a higher incidence of MACE (OR 0.99, 95% CI 0.55–1.77). Conclusions: PPIs are superior to H2RAs for gastroprotection in patients on DAPT. However, PPIs are associated with HTPR, with no significant difference demonstrated in MACE. Based on currently available data, the use of PPIs may be warranted in selected patients on DAPT deemed at risk for GI complications.

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“…Further, a recent systematic review of stress ulcer prophylaxis in ICU patients receiving enteral nutrition and a clinical scenario–based meta‐analysis suggested no statistical association with CDI incidence . An analytic modeling study in the ICU supports a histamine 2 receptor antagonist strategy over PPI therapy in the ICU based on many factors including CDI risk, but despite these findings, critical care–emphasized international guidelines for sepsis have not yet declared a preference for either modality when selecting therapy for stress ulcer prophylaxis . Systematic processes to discontinue unnecessary stress ulcer prophylaxis, particularly PPIs, in ICU patients are important.…”

Section: Acid Suppressionmentioning

confidence: 99%

Prevention of Clostridium difficile Infection in Critically Ill Adults

et al. 2019

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The incidence and severity of Clostridium difficile infection (CDI) remain high across intensive care units in the United States despite national efforts to decrease this escalating health care burden. Most published literature and guidelines address treatment rather than prevention, yet this approach may be too downstream to limit morbidity and mortality from the disease and its complications. Mechanisms to prevent CDI successfully include reducing modifiable risk factors and minimizing horizontal transmission of C. difficile spores between patients and the health care environment. Because CDI prevention is characterized by a bundled approach, it is difficult to quantify the individual impact of any one element; however, a number of patient‐ and facility‐level strategies can be considered for CDI prevention. Robust hygiene strategies, diagnostic and antimicrobial stewardship, and particular prophylaxis maneuvers such as continuation of oral vancomycin or fidaxomicin in the setting of systemic antibiotics have all demonstrated benefit. The preventive roles of deprescribing acid suppressants, routine use of probiotics, or early fecal microbiota transplantation remain unclear. The focus of this review is to summarize the evidence related to primary and secondary CDI prevention in critically ill adults and provide a concise implementation pathway for clinicians and policymakers.

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Cost‐Effectiveness of Histamine₂Receptor Antagonists Versus Proton Pump Inhibitors for Stress Ulcer Prophylaxis in Critically Ill Patients

Cited by 28 publications

References 40 publications

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

H2 Receptor Antagonists versus Proton Pump Inhibitors in Patients on Dual Antiplatelet Therapy for Coronary Artery Disease: A Systematic Review

Prevention of Clostridium difficile Infection in Critically Ill Adults

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Cost‐Effectiveness of Histamine2Receptor Antagonists Versus Proton Pump Inhibitors for Stress Ulcer Prophylaxis in Critically Ill Patients

Cited by 28 publications

References 40 publications

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

H2 Receptor Antagonists versus Proton Pump Inhibitors in Patients on Dual Antiplatelet Therapy for Coronary Artery Disease: A Systematic Review

Prevention of Clostridium difficile Infection in Critically Ill Adults

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Cost‐Effectiveness of Histamine₂Receptor Antagonists Versus Proton Pump Inhibitors for Stress Ulcer Prophylaxis in Critically Ill Patients