Probabilistic Sensitivity Analyses
The probabilistic cost analysis confirmed that iv PPI
was a cost-saving alternative. The mean incremental
saving per subject was $900 (95% CI $270–$1640).
The discrepancy of $20 per subject between the
base case scenario, deterministic analysis, and the
probabilistic analysis originates from the skewed
shape of some distributions fitted to study parameters. Over 99% of the simulated incremental costs
per subject were cost-saving or neutral. The varia-bles that contributed the most to the variance of the
incremental cost per subject were the relative risk of
a first bleeding recurrence at 40.3%, the baseline
probability of a first rebleed at 27.2%, the proportion of subjects with confirmed diagnosis of peptic
ulcer disease at 18.4%, and the probability of a second bleeding recurrence at 4.5%.
The results of the probabilistic model on other
outcomes also favored the iv PPI treatment strategy.
For each 1000 subjects, the estimated reduction in
the mean numbers of recurrent bleeds was 38 (95%
CI 18–61); surgical procedures, 9 (95% CI 3–16);
and days in hospital, 215 (95% CI 116–400).
When relying on efficacy estimates from our
meta-analysis of three iv PPI trials using the 80-mg
bolus and 8 mg/hours continuous infusion strength
[5–7], the conclusion of early initiation of iv PPI
being cost-saving was confirmed. The mean incremental saving per patient was $560 (95% CI $50–
$1180).
Probabilistic Sensitivity Analyses
The probabilistic cost analysis confirmed that iv PPI
was a cost-saving alternative. The mean incremental
saving per subject was $900 (95% CI $270–$1640).
The discrepancy of $20 per subject between the
base case scenario, deterministic analysis, and the
probabilistic analysis originates from the skewed
shape of some distributions fitted to study parameters. Over 99% of the simulated incremental costs
per subject were cost-saving or neutral. The varia-bles that contributed the most to the variance of the
incremental cost per subject were the relative risk of
a first bleeding recurrence at 40.3%, the baseline
probability of a first rebleed at 27.2%, the proportion of subjects with confirmed diagnosis of peptic
ulcer disease at 18.4%, and the probability of a second bleeding recurrence at 4.5%.
The results of the probabilistic model on other
outcomes also favored the iv PPI treatment strategy.
For each 1000 subjects, the estimated reduction in
the mean numbers of recurrent bleeds was 38 (95%
CI 18–61); surgical procedures, 9 (95% CI 3–16);
and days in hospital, 215 (95% CI 116–400).
When relying on efficacy estimates from our
meta-analysis of three iv PPI trials using the 80-mg
bolus and 8 mg/hours continuous infusion strength
[5–7], the conclusion of early initiation of iv PPI
being cost-saving was confirmed. The mean incremental saving per patient was $560 (95% CI $50–
$1180).
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