title: Cost implications of administering intravenous proton pump inhibitors to all patients presenting to the emergency department with peptic ulcer bleeding.
abstract: OBJECTIVE
  Administering proton pump inhibitors (PPI) intravenously (iv) after endoscopic treatment of bleeding peptic ulcers reduces the incidence of rebleeding, the need for operative procedures, and hospitalizations. We assessed the cost implications of iv PPI initiated in all patients presenting to the emergency department (ED) with signs of upper gastrointestinal (UGI) bleeding.
  
  
  METHODS
  From a third-party payer perspective with a time horizon of 60 days, we built a decision analytic model comparing standard endoscopic therapy to a strategy in which all patients presenting to the ED with UGI bleeding would start iv PPI before endoscopy. After endoscopy, only those with peptic ulcers would be kept on iv PPI added to standard therapy. Probabilities of health events were extracted from published literature. Resource utilization profiles and costs (iv PPI, hospital stay for medical and operative procedures, and professional fees) were based on Medicare reimbursement data from a large hospital in Alabama. All costs were expressed in 2000 US dollars. Uncertainty was investigated through one-way sensitivity analyses and probabilistic analyses using Monte Carlo simulations.
  
  
  RESULTS
  In a hypothetical group of 1000 individuals, routine use of iv PPI prevented 40 rebleeds, 9 surgical procedures, and 223 hospital days, and led to incremental savings of dollars 920 per subject. Probabilistic sensitivity analyses indicated that the strategy of using iv PPI was likely to be dominant even when accounting for uncertainty.
  
  
  CONCLUSIONS
  Based on available evidence, routine administration of iv PPI to all persons presenting with UGI bleeding represents good value for money and merits consideration as standard hospital policy.
authors.affiliation: Occam Research & Consulting Inc, Vancouver, British Columbia, Canada.
authors.forename: Yves M
authors.initials: YM
authors.lastname: Gagnon
authors.forename: Adrian R
authors.initials: AR
authors.lastname: Levy
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
authors.forename: Miguel R
authors.initials: MR
authors.lastname: Arguedas
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Rioux
authors.forename: Robert A
authors.initials: RA
authors.lastname: Enns
mesh_terms: D000897:Anti-Ulcer Agents / Q000191:economics* / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D016527:Drug Costs; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000191:economics; D054328:Proton Pump Inhibitors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors