Decision model of the cost and efficacy of
sucralfate and
cimetidine, two commonly used drugs for prophylaxis of stress-related
hemorrhage. Outcome estimates were based on data from published studies. Cost data were based on cost of medications and costs of treatment protocols at our institutions.
MEASUREMENTS AND MAIN RESULTS: The marginal cost-effectiveness of prophylaxis, as compare with no prophylaxis, was calculated separately for
sucralfate and
cimetidine and expressed as cost per
bleeding episode averted. An incremental cost-effectiveness analysis was subsequently employed to compare the two agents. Sensitivity analyses of the effects of the major clinical outcomes on the cost per
bleeding episode averted were performed. At the base-case assumptions of 6% risk of developing stress-related
hemorrhage and 50% risk-reduction due to prophylaxis, the cost of
sucralfate was $1,144 per
bleeding episode averted. The cost per
bleeding episode averted was highly dependent on the risk of
hemorrhage and, to a lesser degree, on the efficacy of
sucralfate prophylaxis, ranging from a cost per
bleeding episode averted of $103,725 for low-risk patients to cost savings for very high-risk patients. The cost per
bleeding episode averted increased significantly if the risk of
nosocomial pneumonia was included in the analysis. The effect of
pneumonia was greater for populations at low risk of
hemorrhage. Assuming equal efficacy, the cost per
bleeding episode averted of
cimetidine was 6.5-fold greater than the cost per
bleeding episode averted of
sucralfate.
CONCLUSIONS: The cost of prophylaxis in patients at low risk of stress-related
hemorrhage is substantial, and may be prohibitive. Further research is needed to identify patient populations that are at high risk of developing stress-related
hemorrhage, and to determine whether prophylaxis increases the risk of
nosocomial pneumonia.