Cost-effectiveness in Canada of intravenous proton pump inhibitors for all patients presenting with acute upper gastrointestinal bleeding.
BACKGROUND
The administration of proton pump inhibitors intravenously after endoscopic treatment of peptic ulcers significantly reduces the recurrence of bleeding.


OBJECTIVE
To evaluate the incremental cost-effectiveness in Canada of intravenous proton pump inhibitor before endoscopic therapy to patients presenting with acute upper gastrointestinal bleeding, compared with endoscopic treatment alone.


METHODS
From a third-party payer perspective, we modelled the costs and effectiveness over 60 days of the two approaches using decision analysis. The probabilities of various outcomes, such as re-bleeding and the need for surgery, were taken from the published literature. We included the costs of intravenous proton pump inhibitor, therapeutic endoscopy, surgical procedures and hospitalizations, all expressed in 2001 Canadian dollars.


RESULTS
In a hypothetical cohort of 1000 patients, the intravenous proton pump inhibitor approach resulted in mean savings of 20,700 Canadian dollars with 37 re-bleeding episodes averted. The investigation of uncertainty resulted in a likelihood of intravenous proton pump inhibitor being cost-effective of at least 0.73.


CONCLUSIONS
It is common in Canada to administer intravenous proton pump inhibitors to patients with upper gastrointestinal bleeding even before endoscopic confirmation of bleeding peptic ulcers. Our results suggest that this approach has a high likelihood of being cost-effective.
Enns
R A
RA
Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. renns@interchange.ubc.ca
Gagnon
Y M
YM
Rioux
K P
KP
Levy
A R
AR
D000208:Acute Disease; D001955:British Columbia; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016099:Endoscopy, Gastrointestinal / Q000191:economics; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000191:economics; D006295:Health Resources / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D018803:Models, Economic; D054328:Proton Pump Inhibitors
D054328:Proton Pump Inhibitors