Published Jan 17, 2013

Quebec, Canada - Proton pump inhibitors (PPI) and H2-receptor antagonists (H2RA) are acid suppressing drugs widely used in medicine, including in the prevention of stress ulcer bleeding (SUB) in critically ill patients in an intensive care unit setting. As a side-effect, these medications can promote ventilator-assisted pneumonia (VAP). The comparative effectiveness and costs of these medications in preventing SUB is not fully understood. A study, “Cost-Effectiveness Analysis: Stress Ulcer Bleeding Prophylaxis with Proton Pump Inhibitors, H2 Receptor Antagonists,” published in Value in Health, set out to assess which preventative medication, PPI or H2RA, is the most cost-effective when trying to prevent stress ulcer bleeding in critically ill patients in an intensive care unit setting. The results of the study indicated that the probabilities of bleeding and pneumonia (a side-effect of therapy) were 1.3% and 10.3% when using PPI prophylaxis versus 6.6% and 10.3% for H2RA prophylaxis, respectively. Considering lengths of stays and per diem costs, the average costs per no complication were US$58,700 for PPI prophylaxis and US$63,920 for H2RA prophylaxis. “This decision model suggests, based on existing published evidence to date, that proton pump inhibitors represent the most cost-effective approach when considering stress ulcer bleeding prophylaxis in the critically ill patients of a modern-day intensive care unit," reports Dr. Alan Barkun, professor of Medicine in McGill University and lead investigator of this economic analysis.

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