Proton pump inhibitors (PPIs) are more effective and less costly than H2-receptor antagonists (H2RAs) in preventing stress ulcer bleeding (SUB) in high-risk patients, according to results of a cost-effectiveness analysis published in Value in Health.

Both PPIs and H2RAs can prevent SUB in patients at high risk, although disparate results have been reported in the medical literature for their comparative efficacies and the risk of ventilator-assisted pneumonia (VAP) as a complication of SUB prophylaxis. In view of the high costs associated with SUB, a cost-effectiveness analysis was undertaken from the third-party payer perspective in the USA to better assess the efficiency of these therapeutic prophylactic agents.

The decision-tree model used a 60-day time horizon, as the analysis focused on inpatient costs only. Patients at high risk of developing SUB in the intensive care unit received prophylactic therapy with a PPI (omeprazole 40 mg/day PO or IV) or an H2RA (famotidine 40 mg IV twice daily). Three possible health states were modelled, including SUB, VAP or no complication.

PPIs had greater efficacy in preventing SUB than H2RAs, and mean costs per patient were $US1250Footnote 1 lower with PPIs. The main outcome was the cost per averted complication, which was $US58 699 for PPIs compared with $63 921 for H2RAs, indicating that PPIs were the dominant strategy.