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High‐dose intravenous proton pump inhibition following endoscopic therapy in the acute management of patients with bleeding peptic ulcers in the USA and Canada: a cost‐effectiveness analysis

2004; Wiley; Volume: 19; Issue: 5 Linguagem: Inglês

10.1046/j.1365-2036.2004.01808.x

1365-2036

Alan Barkun, Karl Herba, V. Adam, Wendy Kennedy, Carlo A Fallone, Marc Bardou,

Helicobacter pylori-related gastroenterology studies

Summary Background : The efficacy of high‐dose intravenous proton pump inhibition has recently been shown, yet its cost‐effectiveness remains poorly studied. Aim : To assess the cost‐effectiveness of this approach separately for American and Canadian health care settings. Methods : A validated decision model included patients with bleeding ulcers after successful endoscopic haemostasis. Probabilities were determined from the literature, and charges and lengths of stay from national databases. A third‐party payer perspective was adopted over a 30‐day time horizon. Results : Re‐bleeding rates were 5.9% for patients who received high‐dose intravenous proton pump inhibition and 22.9% for those who did not. Hospitalization costs for patients with and without re‐bleeding were US$11 802 and US$7993, and CAN$5220 and CAN$2696, respectively. High‐dose intravenous proton pump inhibition was more effective and less costly than the alternative of not administering it. The cost‐effectiveness ratios for high‐dose and no high‐dose intravenous proton pump inhibition were US$9112 and US$11 819 (CAN$3293 and CAN$4284 for the Canadian case), respectively. Sensitivity and threshold analyses showed that the results were robust across a wide range of clinically relevant assumptions. Conclusion : In the USA and Canada, administering high‐dose intravenous proton pump inhibition for 3 days is both more effective and less costly than not doing so for patients with bleeding ulcers after successful endoscopic haemostasis.