PHARMACOECONOMIC ANALYSIS OF STRESS-ULCER PROPHYLAXIS FOR CRITICALLY ILL PATIENTS

The objective of this study was to evaluate the economic outcomes of d rug options for stress ulcer prophylaxis in critically ill and/or inte nsive care unit patients. Decision analytic modelling was used to comp are the costs of stress ulcer prophylaxis and possible clinical outcom es [acute upper gastrointestinal bleeding (AUGB) and nosocomial pneumo nia]. The regimens evaluated were: antacids, histamine H-2 receptor an tagonists (H(2)RAs), sucralfate and no prophylaxis. The results of pub lished studies were pooled to determine the expected probability of AU GB and nosocomial pneumonia following stress ulcer prophylaxis with ea ch of the agents under study. The costs of stress ulcer prophylaxis, t reatment of AUGB and treatment of nosocomial pneumonia were identified from various sources. Sucralfate was the least costly agent for stres s ulcer prophylaxis. The average net costs per patient for sucralfate, antacids, no prophylaxis and H(2)RAs were $US1457, $US1737, $US2268, and $US2638 to $US2712, respectively (1994 dollars). No prophylaxis wa s found to be less costly than giving H(2)RAs. Sucralfate and antacids , which induced net savings of $US7373 and $US4321 per case of AUGB av erted, respectively, were more cost effective than H(2)RAs. Sensitivit y and threshold analyses revealed that the results were constant over a wide range of cost and probability values. Break-even analysis sugge sted that sucralfate was the optimal agent for stress ulcer prophylaxi s unless the acquisition cost of a prophylactic course of sucralfate w as >$US304.05 per patient. At that point, antacids become the optimal agent. Based on this analysis, sucralfate may be the most cost-effecti ve agent for stress ulcer prophylaxis in critically ill or intensive c are patients.