Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage: a cost-effectiveness analysis.
BACKGROUND
Erythromycin is a potent stimulator of gastrointestinal motility. Recent studies have examined the use of intravenous erythromycin to clear the stomach of blood before oesophago-gastroduodenoscopy (EGD) for acute upper gastrointestinal haemorrhage (UGIH). These studies have shown clinical effectiveness.


OBJECTIVE
To evaluate the cost-effectiveness of this intervention.


METHODS
We sought to determine the cost-effectiveness of erythromycin before EGD from the payer's perspective. We found three relevant studies of erythromycin and used these data for the analysis. We obtained costs for intravenous erythromycin and charges for peptic ulcer hospitalization, EGD, surgery, and angiographic embolization. Complication rates were also incorporated from the literature. We implemented a model of health-related quality of life to measure the impact of the intervention. We created a decision-analysis tree and performed a probabilistic sensitivity analysis.


RESULTS
A strategy of erythromycin prior to EGD resulted in a cost-effective outcome in a majority of trials using willingness-to-pay figures of USD 0, USD 50,000 and USD 100,000 per quality-adjusted life-year (QALY).


CONCLUSIONS
Because of the implications for cost saving and increase in QALY, we would recommend giving erythromycin prior to EGD for UGIH.
Winstead
N S
NS
Gastroenterology and Hepatology, University of Alabama-Birmingham, Birmingham, AL, USA. twinstead@uab.edu
Wilcox
C M
CM
D000208:Acute Disease; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004724:Endoscopy / Q000191:economics* / Q000379:methods; D004917:Erythromycin / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic
D005765:Gastrointestinal Agents; D004917:Erythromycin