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Naghmeh Foroutan
Fanak Fahimi
Yasamin Dabiri
Arash Foroutan
Maryam Habibi
Jamshid Salamzadeh


Budget impact, upper GI bleeding, proton pump inhibitors (PPIs), oral suspension, critically ill patients



The aim of the present study was to estimate the financial consequence of using omeprazole immediate-release (IR) oral suspension versus pantoprazole intravenous infusion for preventing stress-related upper gastrointestinal bleeding in critically ill patients from the perspective of the health care system.


An Excel-based model was developed to compare the cost of prevention of upper gastrointestinal bleeding early after intensive care admission using the current intravenous ( IV ) pantoprazole formulation versus omeprazole IR oral suspension. Total costs inc luded the cost of acid suppressive drugs and related clinical outcomes. Inputs were obtained from a local clinical trial, the Ministry of Health database, insurance organizations, hospital and pharmacy registries, the relevant literature, and expert opinion. The robustness of the input data was investigated by one -way sensitivity analysis. The model was developed based on the results of a randomized control trial (RCT ), in which experimental and control groups received omeprazole and pantoprazole, respectively.


According to the proposed model, the cost of gastrointestinal ( GI ) bleeding prevention using pantoprazole IV was US$ 950,000 while US$ 750,000 was spent on receiving omeprazole oral suspension. These costs led to the annual cost -saving of almost US$ 200,000 ( US$ 4 per member, per month) for the health care system.


In the present study, a budget impact analysis was performed to assess the financial consequences of using omeprazole IR oral suspension in place of pantoprazole IV for prevention of upper gastrointestinal bleeding. The better preventive effect of omeprazole IR oral suspension when compared with conventional therapy using pantoprazole IV was the major reason for the final comparative budgetary savings.

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