The use of intravenous proton pump inhibitors (PPIs) before an endoscopy in upper-gastrointestinal (GI) bleeding was shown to reduce the need of endoscopic therapy and shorten hospital stay.
Dr Joseph Sung and colleagues from Hong Kong investigate whether preemptive use of a proton pump inhibitor in upper-GI bleeding is a cost-effective strategy.
|The direct cost per patient was $2,813 with PPIs vs $2,948 with placebo|
The team constructed a decision analysis model that represents treatment pathways for patients with upper-GI bleeding, and structuralized by 30-day outcomes.
Direct costs of medical treatment, diagnostic and therapeutic endoscopy, endoscopic re-treatment, surgery, and hospitalization were analyzed.
A total of 631 patients were recruited.
Of these, 60 patients received proton pump inhibitors group, and 90 patients were in the placebo group required endoscopic hemostasis at index endoscopy.
The primary measurements were cost-effectiveness ratios and incremental cost-effectiveness ratios to avert endoscopic therapy between proton pump inhibitors and placebo treatment.
The team conducted sensitivity analyses by varying the cost of endoscopy, hospitalization, the incidence rate of endoscopic therapy, and the proportion of bleeding peptic ulcers.
The researchers found that the overall direct cost per patient was $2,813 for proton pump inhibitor treatment, and $2,948 with placebo.
A proton pump inhibitor reduced endoscopic therapy by 7%, and resulted in a lower cost-effectiveness ratio per endoscopic therapy averted.
The team found that the incremental cost-effectiveness ratios value was -$1,843.
The result indicates that preemptive proton pump inhibitor treatment is more effective, and less costly for upper-GI bleeding .
When the proportions of patients with peptic ulcer bleeding were greater than 8% the preemptive proton pump inhibitor treatment remained cost saving.
Dr Sung's team concluded, "Preemptive use of intravenous proton pump inhibitors before an endoscopy is a cost-effective strategy in the management of upper-GI bleeding."