| Summary: | 碩士 === 高雄醫學大學 === 藥學研究所碩士在職專班 === 93 === Background: Non-variceal upper gastrointestinal bleeding (UGIB) is a common cause of hospitalization all over the world including in Taiwan. Recent data indicate that IV proton pump inhibitors (PPIs) have the potential to treat UGIB. Despite clinical evidence in favour of IV PPIs, FDA has not yet been proved PPIs in this indication. Data on the cost-effectiveness of this approach in Taiwan is still lacking.
Objectives: The objective is to compare the cost- effectiveness of IV PPIs and Histamin2-recptor antagonist（H2-RA）in the treatment of UGIB. We assessed the effect of initial medication choice (ie, PPIs, H2-RA, or others) following endoscopic haemostasis on cost using healthcare claims data in Taiwan .
Methods: This study was a 2-year, retrospective longitudinal analysis of data from the healthcare claims in southern Taiwan, with about 3 million members, between January 1, 2002, and January 31, 2004. On the basis of International Classification of Disease, Ninth Revision, Clinical modification (ICD-9-CM), we constructed a decision tree model comparing three main strategies: IV PPIs started、IV H2-RA started and others started in non-variceal UGIB patients following endoscopic therapy. The decision analysis used base case estimates of the most likely clinical scenarios and then used sensitivity analysis to evaluate the strategies. Outcome measure was the 60-day rebleeding rate.
Failure is rebleed within 60 days. Effectiveness was reported as the percentage of patients in whom rebleeding was prevented. The model evaluated the rebleeding to initial therapy and the rebleeding prevented by competing different strategies.
Results：After endoscopic therapy, rebleeding rate is still high in Taiwan. Rebleeding appears to correlate with clinical characteristics of the patients: it increase with age, comorbidity, and drugs used. Among drugs, NSAIDS are associated with higher risk of UGIB.
Conclusion: The analysis demonstrates that the use of IV H2-RA in conjunction with endoscopy haemostasis was both superior effectiveness and lower cost based on the probability determination used in the sensitivity analysis.
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