Cost Implications of Administering Intravenous Proton Pump Inhibitors to All Patients Presenting to the Emergency Department with Peptic Ulcer Bleeding

摘要: Abstract Objectives Administering proton pump inhibitors (PPI) intravenously (iv) after endoscopic treatment of bleeding peptic ulcers reduces the incidence rebleeding, need for operative procedures, and hospitalizations. We assessed cost implications iv PPI initiated in all patients presenting to emergency department (ED) with signs upper gastrointestinal (UGI) bleeding. Methods From a third-party payer perspective time horizon 60 days, we built decision analytic model comparing standard therapy strategy which ED UGI would start before endoscopy. After endoscopy, only those be kept on added therapy. Probabilities health events were extracted from published literature. Resource utilization profiles costs (iv PPI, hospital stay medical professional fees) based Medicare reimbursement data large Alabama. All expressed 2000 US dollars. Uncertainty was investigated through one-way sensitivity analyses probabilistic using Monte Carlo simulations. Results In hypothetical group 1000 individuals, routine use prevented 40 rebleeds, 9 surgical 223 led incremental savings $920 per subject. Probabilistic indicated that likely dominant even when accounting uncertainty. Conclusions Based available evidence, administration persons represents good value money merits consideration as policy.