Barkun A N, Herba K, Adam V, Kennedy W, Fallone C A, Bardou M
Division of Gastroenterology, McGill University, Montréal, Québec, Canada.
Aliment Pharmacol Ther. 2004 Mar 1;19(5):591-600. doi: 10.1046/j.1365-2036.2004.01808.x.
The efficacy of high-dose intravenous proton pump inhibition has recently been shown, yet its cost-effectiveness remains poorly studied.
To assess the cost-effectiveness of this approach separately for American and Canadian health care settings.
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.
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 11,802 US dollars and 7993 US dollars, and 5220 Canadian dollars and 2696 Canadian dollars, 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 9112 US dollars and 11,819 US dollars (3293 dollars and 4284 dollars for the Canadian case), respectively. Sensitivity and threshold analyses showed that the results were robust across a wide range of clinically relevant assumptions.
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.
高剂量静脉注射质子泵抑制剂的疗效最近已得到证实，但其成本效益仍研究不足。
分别评估美国和加拿大医疗环境下这种治疗方法的成本效益。
一个经过验证的决策模型纳入了内镜止血成功后发生出血性溃疡的患者。概率根据文献确定，费用和住院时间来自国家数据库。采用第三方支付者视角，时间跨度为30天。
接受高剂量静脉注射质子泵抑制剂的患者再出血率为5.9%，未接受的患者为22.9%。有再出血和无再出血患者的住院费用分别为11,802美元和7993美元，以及5220加元和2696加元。高剂量静脉注射质子泵抑制剂比不使用该药物更有效且成本更低。高剂量和非高剂量静脉注射质子泵抑制剂的成本效益比分别为9112美元和11,819美元（加拿大情况为3293加元和4284加元）。敏感性和阈值分析表明，在广泛的临床相关假设下，结果是稳健的。
在美国和加拿大，对于内镜止血成功后发生出血性溃疡的患者，给予3天高剂量静脉注射质子泵抑制剂比不给予更有效且成本更低。
