Cost-effectiveness of proton pump inhibitor therapy for acute peptic ulcer-related bleeding.
OBJECTIVE
The purpose of this investigation was to perform a cost-effectiveness analysis of adjunctive oral and intravenous proton pump inhibitor (PPI) therapies for patients with acute peptic ulcer-related bleeding of sufficient severity to warrant hospitalization.


METHODS
Cost-effectiveness investigation. Four clinical scenarios were considered: scenario 1, diagnostic endoscopy with oral PPI therapy; scenario 2, diagnostic and therapeutic endoscopy with high-dose intravenous PPI therapy; scenario 3, diagnostic and therapeutic endoscopy available with oral PPI therapy; and scenario 4, diagnostic and therapeutic endoscopy (no PPI). Effectiveness was evaluated in terms of episodes of bleeding averted and quality-adjusted life years.


METHODS
University teaching hospital in the United States.


METHODS
Hospitalized patients with acute peptic ulcer bleeding.


METHODS
None.


RESULTS
Therapeutic endoscopy with high-dose intravenous PPI therapy (scenario 2) was the most cost-effective approach in terms of bleeding episode averted (8,490 vs. 10,201 US dollars for scenario 1, 8,756 US dollars for scenario 3, and 12,459 US dollars for scenario 4) and per quality-adjusted life year (4,810 vs. 5,533 US dollars for scenario 1, 4,946 US dollars for scenario 3, and 5,876 US dollars for scenario 4). The high-dose intravenous PPI scenario was the dominant approach as evidenced by both superior effectiveness and lower costs over the range of probability and cost variables used in the sensitivity analysis. However, the dominance would be lost if the purchase cost of the intravenous PPI was substantially higher than the baseline cost assumed in this investigation (61 US dollars per 3-day course of therapy).


CONCLUSIONS
High-dose intravenous PPI therapy in conjunction with therapeutic endoscopy is the most cost-effective approach for the management of hospitalized patients with acute peptic ulcer bleeding.
Erstad
Brian L
BL
Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, 85721-0207, USA. erstad@pharmacy.arizona.edu
D000208:Acute Disease; D000284:Administration, Oral; D003362:Cost-Benefit Analysis; D016099:Endoscopy, Gastrointestinal; D006760:Hospitalization; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000601:surgery; D054328:Proton Pump Inhibitors
D054328:Proton Pump Inhibitors