کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
3284305 | 1209200 | 2008 | 8 صفحه PDF | دانلود رایگان |
عنوان انگلیسی مقاله ISI
Cost-Effectiveness of Proton-Pump Inhibition Before Endoscopy in Upper Gastrointestinal Bleeding
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کلمات کلیدی
DRGPPIICERUGIBRIWLos - اینUpper gastrointestinal bleeding - خونریزی گوارشی بالاCer - سرlength of stay - طول مدت اقامتProton pump inhibitor - مهار کننده پمپ پروتونcost-effectiveness ratio - نسبت هزینه بهره وریIncremental cost-effectiveness ratio - نسبت هزینه-بهره وری افزایشیDiagnosis-related group - گروه مربوط به تشخیص
موضوعات مرتبط
علوم پزشکی و سلامت
پزشکی و دندانپزشکی
بیماریهای گوارشی
پیش نمایش صفحه اول مقاله
چکیده انگلیسی
Background & Aims: Randomized trials suggest high-dose proton-pump inhibitors (PPIs) administered before gastroscopy in suspected upper gastrointestinal bleeding downstage bleeding ulcer stigmata. We assessed the cost-effectiveness of this approach. Methods: A decision model compared high-dose IVPPI initiated while awaiting endoscopy with IVPPI administration on the basis of endoscopic findings. IVPPIs were given to all patients undergoing endoscopic hemostasis for 72 hours thereafter. Once the IV regimen was completed or for patients with low-risk endoscopic lesions, an oral daily PPI was given for the remainder of the time horizon (30 days after endoscopy). The unit of effectiveness was the proportion of patients without rebleeding, representing the denominator of the cost-effectiveness ratio (cost per no rebleeding). Probabilities and costs were derived from the literature and national databases. Results: IVPPIs before endoscopy were both slightly more costly and effective than after gastroscopy in the U.S. and Canadian settings, with cost-effectiveness ratios of US$5048 versus $4933 and CAN$6064 versus $6025 and incremental costs of US$45,673 and CAN$19,832 to prevent one additional rebleeding episode, respectively. Sensitivity analyses showed robust results in the US In Canada, intravenous proton-pump inhibitors (IVPPIs) before endoscopy became more effective and less costly (dominant strategy) when the uncomplicated stay for high-risk patients increased above 6 days or that of low-risk patients decreased below 3 days. Conclusions: With conservative estimates and high-quality data, IVPPIs given before endoscopy are slightly more effective and costly than no administration. In Canada, this approach becomes dominant as the duration of hospitalization for high-risk ulcer patients increases or that of low-risk ulcer patients decreases.
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Clinical Gastroenterology and Hepatology - Volume 6, Issue 4, April 2008, Pages 418-425
Journal: Clinical Gastroenterology and Hepatology - Volume 6, Issue 4, April 2008, Pages 418-425
نویسندگان
Salman Al-Sabah, Alan N. Barkun, Karl Herba, Viviane Adam, Carlo Fallone, Serge Mayrand, Gilles Pomier-Layrargues, Wendy Kennedy, Marc Bardou,