Winstead N S, Wilcox C M
Gastroenterology and Hepatology, University of Alabama-Birmingham, Birmingham, AL, USA.
Aliment Pharmacol Ther. 2007 Nov 15;26(10):1371-7. doi: 10.1111/j.1365-2036.2007.03516.x. Epub 2007 Sep 10.
Erythromycin is a potent stimulator of gastrointestinal motility. Recent studies have examined the use of intravenous erythromycin to clear the stomach of blood before oesophago-gastroduodenoscopy (EGD) for acute upper gastrointestinal haemorrhage (UGIH). These studies have shown clinical effectiveness.
To evaluate the cost-effectiveness of this intervention.
We sought to determine the cost-effectiveness of erythromycin before EGD from the payer's perspective. We found three relevant studies of erythromycin and used these data for the analysis. We obtained costs for intravenous erythromycin and charges for peptic ulcer hospitalization, EGD, surgery, and angiographic embolization. Complication rates were also incorporated from the literature. We implemented a model of health-related quality of life to measure the impact of the intervention. We created a decision-analysis tree and performed a probabilistic sensitivity analysis.
A strategy of erythromycin prior to EGD resulted in a cost-effective outcome in a majority of trials using willingness-to-pay figures of USD 0, USD 50,000 and USD 100,000 per quality-adjusted life-year (QALY).
Because of the implications for cost saving and increase in QALY, we would recommend giving erythromycin prior to EGD for UGIH.
红霉素是胃肠道动力的强效刺激剂。最近的研究探讨了在急性上消化道出血（UGIH）进行食管胃十二指肠镜检查（EGD）前使用静脉注射红霉素清除胃内血液的情况。这些研究已显示出临床疗效。
评估该干预措施的成本效益。
我们试图从支付者角度确定EGD前使用红霉素的成本效益。我们找到了三项关于红霉素的相关研究，并将这些数据用于分析。我们获取了静脉注射红霉素的成本以及消化性溃疡住院、EGD、手术和血管造影栓塞的费用。并发症发生率也来自文献。我们采用了健康相关生活质量模型来衡量该干预措施的影响。我们创建了一个决策分析树并进行了概率敏感性分析。
在大多数试验中，使用每质量调整生命年（QALY）支付意愿数字为0美元、50,000美元和100,000美元时，EGD前使用红霉素的策略产生了具有成本效益的结果。
鉴于对节省成本和提高QALY的影响，我们建议在UGIH的EGD前给予红霉素。
