Cost-effectiveness of proton pump inhibitor therapy for acute peptic ulcer-related bleeding*

Erstad, Brian L.

doi:10.1097/01.ccm.0000127261.09066.6e

Cited by 32 publications

(14 citation statements)

References 41 publications

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“…Randomized controlled trials support the cost-effectiveness of IV PPIs in the setting of peri-endoscopic hemostasis of bleeding peptic ulcers [23][24][25][26]. However, inappropriate IV PPI prescribing habits are associated with significant additional costs.…”

Section: Discussionmentioning

confidence: 97%

Use of Intravenous Proton-Pump Inhibitors in a Teaching Hospital Practice

2008

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Section: Discussionmentioning

confidence: 97%

Use of Intravenous Proton-Pump Inhibitors in a Teaching Hospital Practice

2008

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“…Previous studies also demonstrated that high-dose intravenous PPI therapy in conjunction with therapeutic endoscopy is the most cost-effective approach for managing hospitalized patients with acute peptic ulcer bleeding [21,22]. Based on our study, it is unknown whether administration of continuous intravenous pantoprazole is cost effective for treating severe erosive esophagitis.…”

Section: Discussionmentioning

confidence: 86%

A Pilot Study of Efficacy and Safety of Continuous Intravenous Infusion of Pantoprazole in the Treatment of Severe Erosive Esophagitis

et al. 2007

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“…[11,52] The cost effectiveness of high-dose IV proton pump inhibitor after successful endoscopic haemostasis has also been compared with oral PPI therapy, but with conflicting results. Two studies showed that high-dose IV proton pump inhibitor therapy was the most cost-effective approach for the management of acute peptic ulcer bleeding, [40,53] but a subsequent study by Spiegel et al [54] reported that the higher effectiveness of IV therapy may not offset its increased costs compared with oral therapy. The reasons for the divergent outcomes are, in part, due to differing assumptions in management approaches and resulting base-case estimates with limited precision of the results.…”

Section: Discussionmentioning

confidence: 98%

Cost Effectiveness of High-Dose Intravenous Esomeprazole for Peptic Ulcer Bleeding

et al. 2010

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Peptic ulcer bleeding (PUB) is a serious and sometimes fatal condition. The outcome of PUB strongly depends on the risk of rebleeding. A recent multinational placebo-controlled clinical trial (ClinicalTrials.gov identifier: NCT00251979) showed that high-dose intravenous (IV) esomeprazole, when administered after successful endoscopic haemostasis in patients with PUB, is effective in preventing rebleeding. From a policy perspective it is important to assess the cost efficacy of this benefit so as to enable clinicians and payers to make an informed decision regarding the management of PUB. Using a decision-tree model, we compared the cost efficacy of high-dose IV esomeprazole versus an approach of no-IV proton pump inhibitor for prevention of rebleeding in patients with PUB. The model adopted a 30-day time horizon and the perspective of third-party payers in the USA and Europe. The main efficacy variable was the number of averted rebleedings. Healthcare resource utilization costs (physician fees, hospitalizations, surgeries, pharmacotherapies) relevant for the management of PUB were also determined. Data for unit costs (prices) were primarily taken from official governmental sources, and data for other model assumptions were retrieved from the original clinical trial and the literature. After successful endoscopic haemostasis, patients received either high-dose IV esomeprazole (80 mg infusion over 30 min, then 8 mg/hour for 71.5 hours) or no-IV esomeprazole treatment, with both groups receiving oral esomeprazole 40 mg once daily from days 4 to 30. Rebleed rates at 30 days were 7.7% and 13.6%, respectively, for the high-dose IV esomeprazole and no-IV esomeprazole treatment groups (equating to a number needed to treat of 17 in order to prevent one additional patient from rebleeding). In the US setting, the average cost per patient for the high-dose IV esomeprazole strategy was $US14 290 compared with $US14 239 for the no-IV esomeprazole strategy (year 2007 values). For the European setting, Sweden and Spain were used as examples. In the Swedish setting the corresponding respective figures were Swedish kronor (SEK)67 862 ($US9220 at average 2006 interbank exchange rates) and SEK67 807 ($US9212) [year 2006 values]. Incremental cost-effectiveness ratios were $US866 and SEK938 ($US127), respectively, per averted rebleed when using IV esomeprazole. For the Spanish setting, the high-dose IV esomeprazole strategy was dominant (more effective and less costly than the no-IV esomeprazole strategy) [year 2008 values]. All results appeared robust to univariate/threshold sensitivity analysis, with high-dose IV esomeprazole becoming dominant with small variations in assumptions in the US and Swedish settings, while remaining a dominant approach in the Spanish scenario across a broad range of values. Sensitivity variables with prespecified ranges included lengths of stay and per diem assumptions, rebleeding rates and, in some cases, professional fees. In patients with PUB, high-dose IV esomeprazole after successful endoscopic haemo...

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Cost-effectiveness of proton pump inhibitor therapy for acute peptic ulcer-related bleeding*

Abstract: 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.

Cited by 32 publications

References 41 publications

Use of Intravenous Proton-Pump Inhibitors in a Teaching Hospital Practice

Use of Intravenous Proton-Pump Inhibitors in a Teaching Hospital Practice

A Pilot Study of Efficacy and Safety of Continuous Intravenous Infusion of Pantoprazole in the Treatment of Severe Erosive Esophagitis

Cost Effectiveness of High-Dose Intravenous Esomeprazole for Peptic Ulcer Bleeding

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