The cost-effectiveness of high-dose oral proton pump inhibition after endoscopy in the acute treatment of peptic ulcer bleeding.
BACKGROUND
Recent data suggest a role for high-dose oral proton pump inhibition in ulcer bleeding.


OBJECTIVE
To compare the cost-effectiveness of oral high-dose proton pump inhibition to both high-dose intravenous proton pump inhibition and placebo administration.


METHODS
The model adopted a 30-day time horizon, and focused on patients with ulcer haemorrhage initially treated endoscopically for high-risk stigmata. Re-bleeding rates were set a priori based on non-head-to-head data from the literature, and charges and lengths of stay from a national American database. Sensitivity analyses were carried across a broad range of clinically relevant assumptions.


RESULTS
Re-bleeding rates for patients receiving intravenous, oral, or placebo therapies were 5.9%, 11.8%, and 27%, respectively. The mean lengths of stay and costs for admitted patients with and without re-bleeding were 4.7 and 3 days; $11,802, and $7993, respectively. High-dose intravenous proton pump inhibition was more effective and less costly (dominant) than high-dose oral proton pump inhibition with incremental savings of $136.40 per patient treated. The oral high-dose strategy in turn dominated placebo administration. Results remained robust according to one- and two-way sensitivity analyses.


CONCLUSIONS
In patients undergoing endoscopic haemostasis, subsequent high-dose intravenous proton pump inhibition is more cost-effective than high-dose oral proton pump inhibition, which in turn dominates placebo. The results from this exploratory-type cost analysis require confirmation by head-to-head prospective trials performed in Western populations.
Barkun
A N
AN
Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital Site, Quebec, Canada. alan.barkun@muhc.mcgill.ca
Herba
K
K
Adam
V
V
Kennedy
W
W
Fallone
C A
CA
Bardou
M
M
D003362:Cost-Benefit Analysis; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D007902:Length of Stay; D018803:Models, Economic; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000191:economics; D054328:Proton Pump Inhibitors; D016032:Randomized Controlled Trials as Topic
D054328:Proton Pump Inhibitors