Pgi5 Cost-Effectiveness of Iv Ppi’s in the Treatment of Non-Variceal Upper Gi Bleeding Following Urgent Endoscopy

Herba, Karl; Barkun, Alan N.; Kennedy, W.R.; Fallone, CA; Investigators, Ascot

doi:10.1016/s1098-3015(10)61126-6

Cited by 4 publications

(5 citation statements)

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“…Previous cost‐effective analyses have demonstrated the superiority of high‐dose IV PPI administration in patients with high‐risk ulcer lesions having undergone initial endoscopic haemostasis 12, 50, 51 . While most of the comparisons have been with placebo, one of the models also favoured this strategy over competing endoscopic approaches (including routine and selective second‐look strategies) when the re‐bleed rate with IV PPI fell below 9% and when their daily cost dropped below $US10 12 …”

Section: Discussionmentioning

confidence: 99%

The cost‐effectiveness of high‐dose oral proton pump inhibition after endoscopy in the acute treatment of peptic ulcer bleeding

Barkun

Herba

Adam

et al. 2004

Aliment Pharmacol Ther

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SUMMARYBackground: Recent data suggest a role for high-dose oral proton pump inhibition in ulcer bleeding. Aim: 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%,

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Section: Discussionmentioning

confidence: 99%

The cost‐effectiveness of high‐dose oral proton pump inhibition after endoscopy in the acute treatment of peptic ulcer bleeding

Barkun

Herba

Adam

et al. 2004

Aliment Pharmacol Ther

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“…Data suggest that initiation of IV pantoprazole is cost-effective in patients with a high risk of ulcer bleeding following urgent endoscopic therapy. 73 IV pantoprazole (80 mg bolus followed by 8 mg/hour for 3 days) demonstrated higher effectiveness (a 17% decrease in rebleeding) at lower cost (CAN$67 less per hospitalized patient) than no treatment. In addition, data from the USA and Canada suggest that administering high-dose IV PPI for 3 days is cost-effective compared with not doing so in patients with bleeding ulcers after successful endoscopic hemostasis.…”

Section: Cost-effectiveness Of Pantoprazole Treatment For Pub and Thementioning

confidence: 98%

“…Data suggest that initiation of IV pantoprazole is cost-effective in patients with a high risk of ulcer bleeding following urgent endoscopic therapy 73. IV pantoprazole (80 mg bolus followed by 8 mg/hour for 3 days) demonstrated higher effectiveness (a 17% decrease in rebleeding) at lower cost (CAN$67 less per hospitalized patient) than no treatment.…”

Section: Cost-effectiveness Of Pantoprazole Treatment For Pub and Thementioning

confidence: 99%

Pantoprazole for the Treatment of Peptic Ulcer Bleeding and Prevention of Rebleeding

Rensburg

Cheer²

2012

Clin Med Insights Gastroenterol

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Adding proton pump inhibitors (PPIs) to endoscopic therapy has become the mainstay of treatment for peptic ulcer bleeding, with current consensus guidelines recommending high-dose intravenous (IV) PPI therapy (IV bolus followed by continuous therapy). However, whether or not high-dose PPI therapy is more effective than low-dose PPI therapy is still debated. Furthermore, maintaining pH ≥ 4 appears to prevent mucosal bleeding in patients with acute stress ulcers; thus, stress ulcer prophylaxis with acid-suppressing therapy has been increasingly recommended in intensive care units (ICUs). This review evaluates the evidence for the efficacy of IV pantoprazole, a PPI, in preventing ulcer rebleeding after endoscopic hemostasis, and in controlling gastric pH and protecting against upper gastrointestinal (GI) bleeding in high-risk ICU patients. The review concludes that IV pantoprazole provides an effective option in the treatment of upper GI bleeding, the prevention of rebleeding, and for the prophylaxis of acute bleeding stress ulcers.

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“…The cost-effectiveness of using proton-pump inhibitors in patients with bleeding peptic ulcers who undergo endoscopy was the topic of several abstracts. It appears to be more cost-effective to select patients with high-risk ulcer bleeding to receive protonpump inhibitors instead of empirical therapy, depending on the endoscopic findings [42,43], or to discontinue therapy in lowrisk patients after endoscopy [44].…”

Section: Endoscopic Techniquesmentioning

confidence: 99%

Esophagogastric Varices and Nonvariceal Bleeding

Kassem

2002

Endoscopy

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General and Diagnostic AspectsThe controversial issue of the cost-effectiveness of screening all cirrhotic patients for esophageal varices was raised in a number of abstracts. In one study using the Markov model, universal endoscopic screening was found not to be cost-effective when compared to empirical medical prophylaxis for variceal bleeding [1]. The cost-effectiveness of screening endoscopy could, however, be improved if a subgroup of cirrhotic patients could be identified that would not need screening for large varices. In this context, absence of splenomegaly and a platelet count > 100 000 were found to be associated with a low risk of developing varices, particularly large varices [2]. This was confirmed in another study in which predictors of the presence of esophageal varices in patients with a recent histological diagnosis of cirrhosis were investigated in 250 patients. Among various clinical, biochemical, and ultrasound variables, a longitudinal spleen diameter of > 112 mm was found to be an independent predictor of the presence of esophageal varices [3]. Endoscopic TechniquesThe importance of identifying the exact site of variceal rupture at endoscopy and subsequent targeted endoscopic treatment was underlined in one study, as it was found to be associated with a significantly lower rebleeding rate [4]. In a study aiming to detect risk factors associated with rebleeding 1 -5 days after variceal ligation, it was found that active bleeding at the index endoscopy was associated with early rebleeding [5]. The shortterm and medium-term mortality rates from bleeding varices treated using endoscopic band ligation were found to be better than those reported in the literature, in a retrospective analysis of data obtained from a North American center [6]. In order to facilitate injection sclerotherapy, a Japanese group designed a transparent hood to be mounted on the tipp of the endoscope, provided with three U-shaped slits to fix the targeted varix during injection [7]. Mini-loop ligation of esophageal varices was tried in another study and was compared to sclerotherapy. It was found to be effective, relatively easy to use, and more tolerable for patients. However, the variceal recurrence rate after 1 year was higher in the mini-loop group [8]. Guiding sclerotherapy with endoscopic ultrasonography to ensure periesophageal vein obliteration was found to be a safe and effective method of treating esophageal varices [9]. However, the authors did not state clearly the advantages achieved by this technique over conventional sclerotherapy.The use of argon plasma coagulation for the eradication of esophageal varices was a topic of one study again this year, in which it was used 7 days after one session of sclerotherapy with 5 % ethanolamine oleate. The entire mucosa of the distal 4 -5 cm of the esophagus was circumferentially coagulated in one session. This was found to be an effective and relatively safe procedure, which was associated with fewer complications in comparison with subjecting the patient to a second s...

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Pgi5 Cost-Effectiveness of Iv Ppi’s in the Treatment of Non-Variceal Upper Gi Bleeding Following Urgent Endoscopy

Cited by 4 publications

References 0 publications

The cost‐effectiveness of high‐dose oral proton pump inhibition after endoscopy in the acute treatment of peptic ulcer bleeding

The cost‐effectiveness of high‐dose oral proton pump inhibition after endoscopy in the acute treatment of peptic ulcer bleeding

Pantoprazole for the Treatment of Peptic Ulcer Bleeding and Prevention of Rebleeding

Esophagogastric Varices and Nonvariceal Bleeding

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