Tsoi Kelvin K F, Lau James Y W, Sung Joseph J Y
Institute of Digestive Disease, the Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Gastrointest Endosc. 2008 Jun;67(7):1056-63. doi: 10.1016/j.gie.2007.11.056. Epub 2008 Apr 14.
The use of intravenous (i.v.) proton pump inhibitors (PPI) before an endoscopy in upper-GI bleeding (UGIB) was shown to reduce the need of endoscopic therapy and shorten hospital stay.
To investigate whether preemptive use of a PPI in UGIB is a cost-effective strategy.
A decision analysis model that represents treatment pathways for patients with UGIB was constructed and structuralized by 30-day outcomes. Direct costs of medical treatment, diagnostic and therapeutic endoscopy, endoscopic re-treatment, surgery, and hospitalization were analyzed.
Prince of Wales Hospital, Hong Kong.
A total of 631 patients were recruited. Sixty patients (19.1%) in the PPI group and 90 patients (28.4%) in the placebo group required endoscopic hemostasis at index endoscopy.
The primary measurements were cost-effectiveness ratios and incremental cost-effectiveness ratios (ICER) to avert endoscopic therapy between PPI and placebo treatment. Sensitivity analyses were conducted by varying the cost of endoscopy, hospitalization, the incidence rate of endoscopic therapy, and the proportion of bleeding peptic ulcers.
The overall direct cost per patient was U.S. dollars (USD) $2813 for PPI treatment and USD $2948 for the placebo. A PPI reduced endoscopic therapy by 7.4% and resulted in a lower cost-effectiveness ratio per endoscopic therapy averted (USD $3561) than the placebo (USD $4117). The ICER value was USD -$1843, which indicated that preemptive PPI treatment is more effective and less costly for UGIB. When the proportions of patients with peptic ulcer bleeding were greater than 8.3%, the preemptive PPI treatment remained cost saving.
Preemptive use of IV PPI before an endoscopy is a cost-effective strategy in the management of UGIB.
上消化道出血（UGIB）患者在内镜检查前使用静脉质子泵抑制剂（PPI）可减少内镜治疗需求并缩短住院时间。
探讨在UGIB中预先使用PPI是否为具有成本效益的策略。
构建了一个代表UGIB患者治疗路径的决策分析模型，并根据30天的结果进行结构化。分析了医疗治疗、诊断性和治疗性内镜检查、内镜再治疗、手术及住院的直接成本。
香港威尔士亲王医院。
共招募631例患者。PPI组60例患者（19.1%）和安慰剂组90例患者（28.4%）在首次内镜检查时需要内镜止血。
主要测量指标为PPI与安慰剂治疗之间避免内镜治疗的成本效益比和增量成本效益比（ICER）。通过改变内镜检查成本、住院成本、内镜治疗发生率和出血性消化性溃疡比例进行敏感性分析。
PPI治疗每位患者的总体直接成本为2813美元，安慰剂为2948美元。PPI使内镜治疗减少了7.4%，且避免每次内镜治疗的成本效益比（3561美元）低于安慰剂（4117美元）。ICER值为 -1843美元，这表明预先使用PPI治疗对UGIB更有效且成本更低。当消化性溃疡出血患者比例大于8.3%时，预先使用PPI治疗仍可节省成本。
在内镜检查前预先使用静脉PPI是管理UGIB的一种具有成本效益的策略。
