title: Costs of treating bleeding and perforated peptic ulcers in The Netherlands.
abstract: OBJECTIVE
  Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs includes perforations and bleeds. Several preventive strategies are being tested for cost-effectiveness, but little is known about the costs of the complications they are trying to prevent. We estimated the direct costs of hospital treatment of bleeding and perforated ulcers in a university hospital, from data in discharge letters and the hospital management information system.
  
  
  METHODS
  Eligible patients had been treated in the VU University Medical Center between January 1997 and August 2000 for an ulcer bleed or perforation (International Classification of Diseases code 531-4). Resource use comprised hospitalization days and diagnostic and therapeutic interventions. Insurance claim prices determined the costs from the payers' perspective. In a secondary analysis we excluded resource use that was clearly related to the treatment of comorbid illness.
  
  
  RESULTS
  Fifty-three patients with a bleeding (n = 35) or perforated ulcer (n = 15) or both (n = 3) were studied, including 14 with comorbidity; 22 complications occurred in the stomach, 29 in the duodenum, one in both stomach and duodenum, and one after partial gastrectomy. A simultaneous bleed and perforation was most expensive (26,000 euro), followed by perforation (19,000 euro) and bleeding (12,000 euro). A bleed in the duodenum was more expensive than in the stomach (13,000 euro vs 10,000 euro), while the opposite was seen for perforations (13,000 euro vs 21,000 euro). Comorbidity increased costs substantially: even after correction for procedures unrelated to the ulcer complication, comorbidity more than doubled the costs of treatment.
  
  
  CONCLUSIONS
  Treatment of complicated ulcers is expensive, especially in patients with comorbid conditions.
authors.affiliation: Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands. M.deleest@vumc.nl
authors.forename: Helena
authors.initials: H
authors.lastname: de Leest
authors.forename: Hiske
authors.initials: H
authors.lastname: van Dieten
authors.forename: Maurits
authors.initials: M
authors.lastname: van Tulder
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.forename: Ben A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: Maarten
authors.initials: M
authors.lastname: Boers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003365:Costs and Cost Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010438:Peptic Ulcer Hemorrhage / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D010439:Peptic Ulcer Perforation / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies