High-dose intravenous proton pump inhibition following endoscopic therapy in the acute management of patients with bleeding peptic ulcers in the USA and Canada: a cost-effectiveness analysis.
BACKGROUND
The efficacy of high-dose intravenous proton pump inhibition has recently been shown, yet its cost-effectiveness remains poorly studied.


OBJECTIVE
To assess the cost-effectiveness of this approach separately for American and Canadian health care settings.


METHODS
A validated decision model included patients with bleeding ulcers after successful endoscopic haemostasis. Probabilities were determined from the literature, and charges and lengths of stay from national databases. A third-party payer perspective was adopted over a 30-day time horizon.


RESULTS
Re-bleeding rates were 5.9% for patients who received high-dose intravenous proton pump inhibition and 22.9% for those who did not. Hospitalization costs for patients with and without re-bleeding were 11,802 US dollars and 7993 US dollars, and 5220 Canadian dollars and 2696 Canadian dollars, respectively. High-dose intravenous proton pump inhibition was more effective and less costly than the alternative of not administering it. The cost-effectiveness ratios for high-dose and no high-dose intravenous proton pump inhibition were 9112 US dollars and 11,819 US dollars (3293 dollars and 4284 dollars for the Canadian case), respectively. Sensitivity and threshold analyses showed that the results were robust across a wide range of clinically relevant assumptions.


CONCLUSIONS
In the USA and Canada, administering high-dose intravenous proton pump inhibition for 3 days is both more effective and less costly than not doing so for patients with bleeding ulcers after successful endoscopic haemostasis.
Division of Gastroenterology, McGill University, Montréal, Québec, Canada. alan.barkun@muhc.mcgill.ca
A N
AN
Barkun
K
K
Herba
V
V
Adam
W
W
Kennedy
C A
CA
Fallone
M
M
Bardou
D000897:Anti-Ulcer Agents / Q000008:administration & dosage* / Q000191:economics; D002170:Canada; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016099:Endoscopy, Gastrointestinal / Q000191:economics* / Q000379:methods; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000191:economics; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000008:administration & dosage; D055502:Secondary Prevention; D016896:Treatment Outcome; D014481:United States
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D017494:Proton Pumps