OBJECTIVES: The objective of the present study was to estimate the financial consequences of using omeprazole immediate-release (IR) oral suspension versus intravenous (IV) infusion of pantoprazole for preventing stress-related upper gastrointestinal bleeding in critically ill patients from the perspective of the health care system.

METHODS: An Excel^®-based model was developed to compare the cost of prevention of upper gastrointestinal bleeding early after intensive care admission using the current IV pantopra­zole formulation versus omeprazole IR oral suspension. Total costs included the cost of acid-suppressive drugs (proton pump inhibitors) and related clinical outcomes. Inputs were obtained from a local clinical trial, the Ministry of Health database, insurance organizations, hospital and pharmacy registries, the relevant literature, and expert opinion. The robustness of the input data was investigated by one-way sensitivity analysis. During the study period (November 2012 to September 2013), 4,150 patients were admitted to intensive care units in the different provinces of Iran. The model was developed based on the results of a randomized controlled trial in which an experimental group and a control group received omeprazole IR oral suspen­sion and pantoprazole IV, respectively.

RESULTS: According to the proposed model, the cost of preventing gastrointestinal bleeding using pantoprazole IV was US$950,000, while US$750,000 was spent on omeprazole IR oral suspension. Replacement of IV pantoprazole by omeprazole IR oral suspension would lead to an annual cost saving of almost US$200,000 (US$4 per member per month) to the health care system. CONCLUSIONS: In the present study, a budget impact analysis was performed to assess the financial consequences of using omeprazole IR oral suspension in place of pantoprazole IV for prevention of upper gastrointestinal bleeding. The better preventive effect of omeprazole IR oral suspension when compared with conventional therapy using pantoprazole IV was the major reason for the final comparative budgetary savings.