Lei Yang, Halasz Jennifer, Novak Kerri L, Congly Stephen E
Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada.
O'Brien Institute of Public Health, University of Calgary, Calgary, AB T2N 4Z6, Canada.
Medicines (Basel). 2023 Jul 20;10(7):44. doi: 10.3390/medicines10070044.
High-dose proton pump inhibitor (PPI) therapy, given either intermittently or continuously for non-variceal upper gastrointestinal bleeding (NV-UGIB), is efficacious. Using intermittent PPI for low-risk patients may be cost-saving. Our objective was to estimate the annual cost savings if all low-risk NV-UGIB patients received intermittent PPI therapy.
Patients who presented to hospital in Calgary, Alberta, who received a PPI for NV-UGIB from July 2015 to March 2017 were identified using ICD-10 codes. Patients were stratified into no endoscopy, high-risk, and low-risk lesion groups and further subdivided into no PPI, oral PPI, intermittent intravenous (IV), and continuous IV subgroups. Average length of stay (LOS) in each subgroup and costs were calculated.
We identified 4141 patients with NV-UGIBs, (median age 61, 57.4% male). One-thousand two-hundred and thirty-one low-risk patients received continuous IV PPI, with an average LOS of 6.8 days (95% CI 6.2-7.3) versus 4.9 days (95% CI 3.9-5.9) for intermittent IV patients. If continuous IV PPI patients instead received intermittent IV PPI, 3852 patient days and CAD 11,714,390 (2017 CAD)/year could be saved.
Using real-world administrative data, we demonstrate that a sizable portion of low-risk patients with NV-UGIB who were given continuous IV PPI if switched to intermittent IV therapy could generate significant potential cost savings.
高剂量质子泵抑制剂（PPI）疗法，无论是间歇性还是持续性用于非静脉曲张性上消化道出血（NV-UGIB），都是有效的。对于低风险患者使用间歇性PPI可能会节省成本。我们的目标是估计如果所有低风险NV-UGIB患者接受间歇性PPI治疗每年可节省的成本。
利用国际疾病分类第十版（ICD-10）编码确定2015年7月至2017年3月在艾伯塔省卡尔加里市住院并接受PPI治疗NV-UGIB的患者。患者被分为未行内镜检查、高风险和低风险病变组，并进一步细分为未使用PPI、口服PPI、间歇性静脉注射（IV）和持续性静脉注射亚组。计算每个亚组的平均住院时间（LOS）和成本。
我们确定了4141例NV-UGIB患者（中位年龄61岁，男性占57.4%）。1231例低风险患者接受持续性静脉注射PPI，平均住院时间为6.8天（95%可信区间6.2-7.3），而间歇性静脉注射患者为4.9天（95%可信区间3.9-5.9）。如果持续性静脉注射PPI的患者改为接受间歇性静脉注射PPI，每年可节省3852个患者住院日和11,714,390加元（2017年加元）。
使用真实世界的管理数据，我们证明了很大一部分接受持续性静脉注射PPI的低风险NV-UGIB患者如果改为间歇性静脉注射治疗可产生显著的潜在成本节省。
