1.png)
The effectiveness and cost of lansoprazole and pantoprazole for stress ulcer prophylaxis in intensive care unit
Abstract
The incidence of bleeding is increased in high risk patients with critical conditions in Intensive Care Unit (ICU). Appropriate prophylaxis medicine is necessary to reduce the incidence of stress ulcer bleeding during hospitalization in ICU which further can minimize the cost of patient care in the ICU. Currently, lansoprazole and pantoprazole are used as a stress ulcers prophylaxis. Nevertheless, there has not been sufficient evidence proving their effectiveness. This study was aimed to compare the effectiveness and cost between iv lansoprazole and iv pantoprazole as a stress ulcer prophylaxis in ICU. In this retrospective observational study, the data were obtained from medical records of all patients admitted to ICU in a District Hospital in Yogyakarta from January 2014 until December 2016. Effectiveness of therapy were obtained from objective data in the medical record by looking at the incidence of major (clinically signiï¬cant) and minor (overt gastrointestinal) bleeding. Chi-square analysis was performed to analyze the difference of bleeding incidence. The average cost was presented as Expected Monetary Value (EMV), which consisted of the cost of prophylaxis and treatment of bleeding. The difference in average cost was analyzed using independent t-test. A total of 119 patients were included in this study. There were 62 patients in the lansoprazole group and 47 patients in the pantoprazole group. Forty eight patients (77,4%) from lansoprazole group and 35 patients (61,4%) from pantoprazole group did not experience any GI bleeding. There was no statistical difference in the incidence of GI bleeding between the two groups (CI 95%, P-value = 0.057). The EMV of lansoprazole group was higher than pantoprazole group IDR 645.122,57 and IDR 511.629,39 respectively. In conclusion, there was no significant difference regarding the effectiveness between iv lansoprazole and iv pantoprazole as stress ulcer prophylaxis. Costs for the prophylaxis of stress ulcers is lower on the use of pantoprazole compared to lansoprazole.
Keywords
Full Text:
PDFReferences
ASHP. (1999). ASHP therapeutic guidelines on stress ulcer prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists, 56(4), 347–379. https://doi.org/10.1093/ajhp/56.4.347
Avendaño-Reyes, J. M., & Jaramillo-RamÃrez, H. (2014). Prophylaxis for stress ulcer bleeding in the intensive care unit. Revista de GastroenterologÃa de México (English Edition), 79(1), 50–55. https://doi.org/10.1016/j.rgmxen.2013.05.001
Aygencel, G., & Turkoglu, M. (2011). Characteristics, outcomes and costs of prolonged stay ICU patients. Dahili ve Cerrahi Bilimler Yoğun Bakım Dergisi/ Turkish Journal of Medical and Surgical Intensive Care, 2, 53–58. https://doi.org/10.5152/dcbybd.2011.12
Barkun, A. N., Adam, V., Martel, M., & Bardou, M. (2013). Cost-effectiveness analysis: stress ulcer bleeding prophylaxis with proton pump inhibitors, H2 receptor antagonists. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 16(1), 14–22. https://doi.org/10.1016/j.jval.2012.08.2213
Burris, A. J. (2014). Proton pump inhibitors vs. histamine2-receptor antagonists for stress ulcer prophylaxis: battle of the acid suppressants
Chubineh, J., & Birk, J. (2012). Proton pump inhibitors: the good, the bad, and the unwanted. 105(11), 613–618. https://doi.org/10.1097/SMJ.0b013e31826efbea
Heidelbaugh, J. J., Goldberg, K. L., & Inadomi, J. M. (2010). Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. 16(9), 228
Kerama, S. K., Okalebo, F. A., Nyamu, D. G., Guantai, E. M., Ndwigah, S. N., & Maru, S. M. (2014). Risk factors and management of stress ulcers in the critical care unit in a kenyan referral hospital. 3(2), 51–61
Khoshbaten, M., Farzin, H., Fattahi, E., & Asl, M. E. (2006). Significant upper gi – bleeding in critically ill patients. The Internet Journal of Gastroenterology, 5(2). https://doi.org/10.5580/2332
Krag, M., Perner, A., Wetterslev, J., Wise, M. P., Borthwick, M., Bendel, S., Pelosi, P., Keus, F., Guttormsen, A. B., Schefold, J. C., & Møller, M. H. (2016). Stress ulcer prophylaxis with a proton pump inhibitor versus placebo in critically ill patients (SUP-ICU trial): Study protocol for a randomised controlled trial. Trials, 17(1), 1–18. https://doi.org/10.1186/s13063-016-1331-3
Lanas, A., GarcÃa-RodrÃguez, L. A., Arroyo, M. T., Gomollón, F., Feu, F., González-Pérez, A., Zapata, E., Bástida, G., Rodrigo, L., Santolaria, S., Güell, M., de Argila, C. M., Quintero, E., Borda, F., Piqué, J. M., & Asociación Española de GastroenterologÃa. (2006). Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut, 55(12), 1731–1738. https://doi.org/10.1136/gut.2005.080754
Mohamad, M. S., Shamsuddin, N., & Tan, K. M. (2015). Appropriateness of stress ulcer prophylaxis among older adults admitted to general medical wards in a university hospital. European Geriatric Medicine, 6(2), 119–123. https://doi.org/10.1016/j.eurger.2014.11.004
Mohebbi, L., & Hesch, K. (2009). Stress ulcer prophylaxis in the intensive care unit. 22(4). https://doi.org/10.1080/08998280.2009.11928562
Mutlu, G. M., Mutlu, E. A., & Factor, P. (2001). GI complications in patients receiving mechanical ventilation. Chest, 119(4), 1222–1241. https://doi.org/10.1378/chest.119.4.1222
Pipilis, A., Makrygiannis, S., Chrisanthopoulou, E., Sourlas, N., Kaliambakos, S., & Ntailianas, P. (2014). Gastrointestinal bleeding in patients receiving antiplatelet and anticoagulant therapy: Practical guidance for restarting therapy and avoiding recurrences. Hellenic Journal of Cardiology: HJC = Hellenike Kardiologike Epitheorese, 55(6), 499–509
Shin, J. M., & Kim, N. (2013). Pharmacokinetics and pharmacodynamics of the proton pump inhibitors. Journal of Neurogastroenterology and Motility, 19(1), 25–35. https://doi.org/10.5056/jnm.2013.19.1.25
Spirt, M. J., & Stanley, S. (2006). Update on stress ulcer prophylaxis in critically ill patients. Critical Care Nurse, 26(1), 18–20, 22–28; quiz 29. https://doi.org/10.4037/ccn2006.26.1.18
Udeh, B. L., Udeh, C., & Hata, J. S. (2010). Cost-Effectiveness of Stress Ulcer Prophylaxis: Role of Proton Pump Inhibitors. 2(5), 9
Yang, Q.-Y., Ouyang, J., & Yang, J.-D. (2018). Sepsis is an important risk factor for gastrointestinal bleeding in acute coronary syndrome patients: Two case reports. Medicine, 97(36), 1–5. https://doi.org/10.1097/MD.0000000000012273
Yasuda, H., Matsuo, Y., Sato, Y., Ozawa, S.-I., Ishigooka, S., Yamashita, M., Yamamoto, H., & Itoh, F. (2015). Treatment and prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy. World Journal of Critical Care Medicine, 4(1), 40–46. https://doi.org/10.5492/wjccm.v4.i1.40
Yazdi, A. P., & Imantalab, M. (2015). Stress-related mucosal disease in critically Ill patients. Journal of Patient Safety & Quality Improvement journal, 3(2), 266–268
DOI: http://dx.doi.org/10.12928/pharmaciana.v11i3.19617
Refbacks
- There are currently no refbacks.
Copyright (c) 2021 Mega - Octavia
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Office: Faculty of Pharmacy, Universitas Ahmad Dahlan
Jl. Prof. Dr. Soepomo, S.H., Janturan, Warungboto, Umbulharjo, Yogyakarta, Indonesia
Kode pos 55164
Email: pharmaciana@pharm.uad.ac.id