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

Barkun, Alan N.; Herba, Karl; Adam, Viviane; Kennedy, Wendy; Fallone, Carlo A; Bardou, Marc

doi:10.1111/j.1365-2036.2004.02035.x

Cited by 44 publications

(25 citation statements)

References 54 publications

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“…Cost-effectiveness analyses showed that intravenous and oral PPI treatment, after endoscopic therapy in patients with high-risk stigmata, is more cost-effective than either placebo and H 2 -receptor antagonists [40,41]. However, when comparing intravenous and oral PPI therapy, one analysis showed the intravenous route to be more costeffective [40], but the other favored oral dosing [41].…”

Section: Intermittent Versus Continuous Ppismentioning

confidence: 97%

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Gastric acid inhibition in the treatment of peptic ulcer hemorrhage

Ghassemi¹,

Kovacs²,

Jensen

2009

Curr Gastroenterol Rep

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Upper gastrointestinal bleeding from peptic ulcer disease is a common clinical event, resulting in considerable patient morbidity and significant health care costs. Inhibiting gastric acid secretion is a key component in improving clinical outcomes, including reducing rebleeding, transfusion requirements, and surgery. Raising intragastric pH promotes clot stability and reduces the influences of gastric acid and pepsin. Patients with high-risk stigmata for ulcer bleeding (arterial bleeding, nonbleeding visible vessels, and adherent clots) benefit significantly from and should receive high-dose intravenous proton pump inhibitors (PPIs) after successful endoscopic hemostasis. For patients with low-risk stigmata (flat spots or clean ulcer base), oral PPI therapy alone is sufficient. For oozing bleeding (an intermediate risk finding), successful endoscopic hemostasis and oral PPI are recommended. Using intravenous PPIs before endoscopy appears to reduce the frequency of finding high-risk stigmata on later endoscopy, but has not been shown to improve clinical outcomes. High-dose oral PPIs may be as effective as intravenous infusion in achieving positive clinical outcomes, but this has not been documented by randomized studies and its cost-effectiveness is unclear.

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Section: Intermittent Versus Continuous Ppismentioning

confidence: 97%

“…However, when comparing intravenous and oral PPI therapy, one analysis showed the intravenous route to be more costeffective [40], but the other favored oral dosing [41].…”

Section: Intermittent Versus Continuous Ppismentioning

confidence: 99%

Gastric acid inhibition in the treatment of peptic ulcer hemorrhage

Ghassemi¹,

Kovacs²,

Jensen

2009

Curr Gastroenterol Rep

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“…Since PPI drugs were entered into clinical for PU therapy, several economic analyses of PPI therapy have been reported. For PU patients having acute ulcer-related bleeding, a high-dose intravenous PPI therapy with therapeutic endoscopy was reported to be the more cost-effective approach than oral PPI therapy with endoscopy or immediate surgery (Barkun et al, 2004(Barkun et al, , 2010Erstad, 2004;Spiegel et al, 2006;Al-Sabah et al, 2008). The clinical economic analyses of PPI therapy for gastroesophageal reflux disease (GERD) were also assessed by comparing non-erosive and erosive patient group (Dean et al, 2004) and by comparing the groups administered different PPI drugs (Hughes et al, 2005;Remák et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic and cost effectiveness of proton pump inhibitor regimens for idiopathic or drug-induced peptic ulcer complication

Nam

Park

et al. 2011

Arch. Pharm. Res.

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Peptic ulcer (PU) disease has a high rate of occurrence and recurrence in Korean and the selection of drug for treatment is diverse. In this study, the therapeutical effectiveness of regimens including proton pump inhibitors (PPI) was compared with the single PPI therapy. The clinical data were collected from 1,658 patients having idiopathic or drug-induced PU complication from a Medical Center in Daegu, Korea, and analyzed retrospectively based on the results of endoscopic examination, the drug history and the therapeutic cost depending on drugs used. The comparison of complete healing rate and recurrence rate showed no significant differences between the single PPI groups and the combination group with antacids, prokinetic agent or mucosa protectants. However, the combination therapy of PPI with mucosa protectants gave a slightly better therapeutic outcome than single PPI treatment in gastric ulcer patients. Comparatively, the combination of PPI with antacids significantly reduced the therapeutic effectiveness in duodenal ulcer patients. The analysis of cost-based therapeutic effectiveness reveals that any economic benefits in PU treatment were not gained by the combination of other class of ulcer drugs. Even though the rapidity of healing rate was not considered, it can be concluded that the PPI combination therapy might be not desirable in PU treatment. Particularly triplet or quartet combination therapy in PPI regimen was absolutely economically ineffective therapy in spite of the increase of medication costs.

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“…Cost-effectiveness analyses in patients with high-risk endoscopic stigmata who had successful endoscopic therapy have shown that both intravenous and oral PPI treatment are more cost-effective than intravenous H 2 RAs [35] or placebo [36]. When intravenous PPI was compared with oral PPI, divergent results were obtained; one analysis favored intravenous use [36] and the other supported oral dosing [35].…”

Section: Medical Managementmentioning

confidence: 96%

Management of upper gastrointestinal bleeding

Kovacs

2008

Curr Gastroenterol Rep

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Upper gastrointestinal bleeding secondary to ulcer disease is common and results in substantial patient morbidity and medical expense. After initial resuscitation to stabilize the patient, carefully performed endoscopy provides an accurate diagnosis and identifies high-risk ulcer patients who are likely to rebleed with medical therapy alone and will benefit most from endoscopic hemostasis. For patients with major stigmata of ulcer hemorrhage--active arterial bleeding, nonbleeding visible vessel, and adherent clot--combination therapy with epinephrine injection and either thermal coagulation (multipolar or heater probe) or endoclips is recommended. High-dose intravenous proton pump inhibitors are recommended as concomitant therapy after successful endoscopic hemostasis. Patients with minor stigmata or clean-based ulcers will not benefit from endoscopic treatment and should receive high-dose oral proton pump inhibitor therapy. Effective medical and endoscopic management of ulcer hemorrhage can significantly improve outcomes and decrease the cost of medical care by reducing rebleeding, transfusion requirements, and the need for surgery.

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

Cited by 44 publications

References 54 publications

Gastric acid inhibition in the treatment of peptic ulcer hemorrhage

Gastric acid inhibition in the treatment of peptic ulcer hemorrhage

Therapeutic and cost effectiveness of proton pump inhibitor regimens for idiopathic or drug-induced peptic ulcer complication

Management of upper gastrointestinal bleeding

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