Cost-effective Selection of H2 Receptor Antagonists for Upper Gastrointestinal Hemorrhage in Japanese Hospital Setting
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Accession number;05A0383647
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| Title;Cost-effective Selection of H2 Receptor Antagonists for Upper Gastrointestinal Hemorrhage in Japanese Hospital Setting |
| Author;
INOUE TADAO
(St. Luke's International Hospital)
FUKUDA SACHIKO
(St. Luke's International Hospital)
FUJITA YOSHIYUKI
(St. Luke's International Hospital)
UETSUKA YOSHIO
(Tokyo Women's Medical Univ.)
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Journal Title;Japanese Journal of Pharmaceutical Health Care and Sciences
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Journal Code:Y0888A
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ISSN:1346-342X
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VOL.31;NO.4;PAGE.261-269(2005)
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| Figure&Table&Reference;FIG.5, TBL.4, REF.16 |
| Pub. Country;Japan |
| Language;English |
| Abstract;The aim of this study was to identify the most favorable H2RA (H2 receptor antagonist) for the treatment of upper gastrointestinal hemorrhage (non-phlebeurysm). A decision tree was constructed to evaluate cost-effectiveness among an existing treatment (control), roxatidine, famotidine and ranitidine from the viewpoints of the payer and the medical facility. Clinical parameters used as transition probabilities were obtained from the results of the domestic RCT (Randomized Controlled Trial) of each drug. The cost items consisted of the direct medical cost, capital cost, and medical staff (doctors and nurses) personnel costs. The time horizon was set at 12.3 days on average and there was therefore no discount. Of the three drugs, at approximately 140,000 yen less than the control, ranitidine was estimated to be most cost-saving for the payer. In percentage terms, ranitidine had the highest earnings rate among the H2RAs of 46.0% and roxatidine had the highest earnings in money terms among the H2RAs of approximately 120,000 yen. A one-way sensitivity analysis used for investigating extra periods of hospitalization showed that this had no impact on the base case. A two-way analysis showed that ranitidine had the highest efficiency of about 55% for the cases analyzed. When a threshold analysis was conducted, it was found that, while there would be no change in the hemostatic rate in substitutive plans, the hemostatic rate of 0.60 for famotidine (ceiling total cost: 375,801 yen) and that of 0.61 for ranitidine (ceiling total cost: 406,271 yen) were the thresholds affecting the results of analysis. It is therefore likely that selecting ranitidine first in preference to roxatidine or famotidine would be more cost-effective. (author abst.) |
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