Cost-effectiveness analysis of high-dose omeprazole infusion as adjuvant therapy to endoscopic treatment of bleeding peptic ulcer.
BACKGROUND
Intravenous administration of proton pump inhibitors after endoscopic treatment of bleeding peptic ulcers has been shown to decrease the rate of recurrent bleeding and the need for subsequent surgery. Yet there is a relative lack of formal assessment of this practice. The aim of this study was to examine the cost-effectiveness of this therapy by using standard pharmacoeconomic methods.


METHODS
The present study was performed in conjunction with a randomized controlled clinical trial that included 232 patients who received either omeprazole (80 mg intravenous bolus followed by infusion at 8 mg/hour for 72 hours) or placebo after hemostasis was achieved endoscopically. A cost-effectiveness analysis was performed to evaluate the different outcomes of the trial. All related direct medical costs were identified from patient records. Cost-effectiveness ratios were calculated.


RESULTS
Analysis by the Kolmogorov-Smirnov test showed that the direct medical cost in the omeprazole group was lower than that for the placebo group. Cost-effectiveness ratios for omeprazole and placebo groups were, respectively, HK$ 28,764 (US$ 3688) and HK$ 36,992 (US$ 4743) in averting one episode of recurrent bleeding in one patient after initial hemostasis was achieved endoscopically.


CONCLUSIONS
Intravenous administration of high-dose omeprazole appears to be a cost-effective therapy in reducing the recurrence of bleeding and need for surgery in patients with active bleeding ulcer after initial hemostasis is obtained endoscopically.
Lee
Kenneth K C
KK
School of Pharmacy, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
You
Joyce H S
JH
Wong
Ian C K
IC
Kwong
Sunny K S
SK
Lau
James Y W
JY
Chan
Thomas Y K
TY
Lau
Joseph T F
JT
Leung
Wilson Y S
WY
Sung
Joseph J Y
JJ
Chung
Sydney S C
SS
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005069:Evaluation Studies as Topic; D005260:Female; D005773:Gastroscopy / Q000191:economics / Q000379:methods; D016558:Hemostasis, Endoscopic / Q000191:economics / Q000379:methods; D017721:Hospital Costs / Q000592:standards* / Q000639:trends; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage* / Q000191:economics*; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000191:economics*; D011336:Probability; D012016:Reference Values; D055502:Secondary Prevention; D006113:United Kingdom
D009853:Omeprazole