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Economic and health aspects of peptic ulcer disease and H2-receptor antagonists

  • Dennis M. Jensen
    Correspondence
    Requests for reprints should be addressed to Dr. Dennis M. Jensen, 44-133 CHS, Division of Gastroenterology, UCLA Center for the Health Sciences, Los Angeles, California 90024.
    Affiliations
    Divisions of Gastroenterology, UCLA School of Medicine, Wadsworth Veterans Administration Hospital, and the Center for Ulcer Research and Education (CURE), Los Angeles, California, USA
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      Abstract

      The costs of peptic ulcer disease to society are very high. Costs can be expressed as either direct or indirect. Direct costs include hospitalization or clinic visits, physicians' fees, and medication. Indirect costs are loss of productivity due to absenteeism from work or loss of income from death of an employee. The daily cost of different ulcer drugs such as the histamine (H2)-receptor antagonists for intravenous treatment, acute healing, and maintenance can easily be compared. As newer anti-ulcer drugs such as H2-receptor antagonists have been introduced into the marketplace, the number of prescriptions and medication costs have increased rather than decreased. In part, this may be accounted for by the high frequency with which H2 antagonists are prescribed for patients with non-ulcer dyspepsia. Some patients have chronic peptic ulcer disease with multiple painful recurrences or complications such as hemorrhage, perforation, or obstruction. They may require long-term care or drug maintenance, hospitalization, or surgery. For patients with chronic ulcer disease or complications, randomized controlled trials to compare the efficacy, safety, and costs of different forms of therapy (maintenance drugs, surgery, or placebo) have not been reported. However, based upon good efficacy and safety for acute healing and long-term drug maintenance for painful duodenal ulcer disease, long-term maintenance with H2-receptor antagonists is now prescribed for many patients. No controlled randomized trials have been reported to document that long-term maintenance with H2-receptor antagonists actually reduces peptic ulcer complications. However, by current cost estimates, long-term H2-receptor antagonist therapy is less expensive than ulcer surgery for uncomplicated ulcer disease for up to eight years. However, maintenance drug therapy after eight years may be more expensive than elective ulcer surgery in patients with chronic peptic ulcer disease who are good surgical candidates. Patients with complications of peptic ulcer disease seem to represent a different subset than patients with symptomatic ulcer disease. Further studies in these subsets are needed to ascertain the most effective, safest, and least expensive management such as surgery, long-term drug maintenance, or intermittent drug therapy to prevent recurrent ulceration or complications. Because of excellent efficacy and safety in controlled clinical trials of symptomatic peptic ulcer disease and the pattern of utilization in other countries such as Japan, famotidine is likely to capture a significant proportion of the H2-receptor antagonist market in the United States. Based upon recent patterns of utilization for H2-receptor antagonists and the cost of developing novel drugs, it seems unlikely that the introduction of new ulcer drugs such as famotidine will further reduce the direct or indirect costs of peptic ulcer disease in the United States. Nevertheless, studies assessing the impact of such anti-ulcer drugs upon the direct and indirect costs of peptic ulcer disease are recommended.
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      References

        • Bodemar G
        • Gottard R
        • Strom M
        • Walan A
        • Jonsson B
        • Bjurulf B
        Socioeconomic aspects of treatment with cimetidine in peptic ulcer disease.
        in: Trosoli A Luchelli PE Brimblecombe RW Further experience with H2-receptor antagonists in peptic ulcer disease and progress in histamine research. Exerpta Medica, Amsterdam1980: 59-69
        • Walker CO
        Complications of peptic ulcer disease and indications for surgery.
        in: Sleisinger MH Fordtran JS Gastrointestinal disease, pathophysiology, diagnosis and management. WB Saunders, Philadelphia1978: 914-931
        • McGuigan JE
        The Zollinger-Ellison syndrome.
        in: Sleisinger MH Fordtran JS Gastrointestinal disease, pathophysiology, diagnosis and management. WB Saunders, Philadelphia1978: 860-874
        • Health and Public Policy Committee, American College of Physicians
        Position paper-endoscopy in the evaluation of dyspepsia.
        Ann Intern Med. 1985; 102: 266-269
        • Jensen DM
        Health and economic aspects of peptic ulcer disease.
        Am J Med. 1984; 77: 8-14
        • Elashoff JD
        • Grossman MI
        Trends in hospital admissions and death rates from peptic ulcer disease in the United States from 1970 to 1978.
        Gastroenterology. 1980; 78: 280-285
        • National Center for Health Statistics
        Monthly Vital Statistics Report: Provisional statistics, annual summary for the United States, 1979. National Center for Health Statistics, Hyattsville, Maryland1980: 28 (no. 13): Department of Health and Human Services no. 81-1120
        • Schade RR
        • Donaldson RW
        How physicians use cimetidine, a survey of hospitalized patients and published cases.
        N Engl J Med. 1981; 304: 1281-1284
        • Legerton CW
        Duodenal and gastric ulcer healing rates: a review.
        Am J Med. 1984; 77: 2-7
        • Hirschowitz BI
        Lessons from the US multicenter trial of ranitidine treatment of duodenal ulcer.
        J Clin Gastroenterol. 1983; 5: 115-122
        • Burland WL
        • Hawkins BW
        • Beresford J
        Cimetidine treatment for prevention of recurrence of duodenal ulcer, an international collaborative study.
        Postgrad Med J. 1980; 56: 173-176
        • Silvis SE
        Results of the United States ranitidine maintenance trials.
        Am J Med. 1984; 77: 33-38
      1. Pharmaceutical Data Services, Alpha System. June 6, 1986.

        • Kahn K
        • Greenfield S
        The efficacy of endoscopy in the evaluation of dyspepsia.
        in: A review of the literature and development of a sound strategy. J Clin Gastroenterol. 8. 1986: 346-358 (3)
        • Gear MWL
        • Barnes RJ
        Endoscopic studies of dyspepsia in general practice.
        Br Med J. 1980; 280: 1136-1137
        • Read L
        • Pass TM
        • Komaroff AL
        Diagnosis and treatment of dyspepsia, a cost effectiveness analysis.
        Med Decis Making. 1982; 2: 416-438
        • Mollmann KM
        • Bonnevie O
        • Gudbrand Hoyer E
        • Wulff HR
        A diagnostic study of patients with upper abdominal pain.
        Scand J Gastroenterol. 1975; 10: 105-109
        • Horrocks JC
        • Dedombal FT
        Clinical presentation of patients with dyspepsia, detailed symptomatic study of 360 patients.
        Gut. 1978; 19: 19-26
        • Stanford Research Institute
        Cost of ulcer disease in the United States.
        Data on file at Smith, Kline and French Laboratories, Philadelphia1977
        • Robinson M
        Review of peptic ulcer maintenance trials.
        Am J Med. 1984; 77: 23-29
        • Debas HT
        New surgical treatments for duodenal ulcer.
        in: Peptic ulcer: new therapies, new diseases. Ann Intern Med. 95. 1981: 609-627
        • Thompson JC
        The role of surgery in peptic ulcers.
        N Engl J Med. 1982; 307: 550-551
        • Jensen HE
        • Kjaergard J
        • Meisner S
        Ulcer recurrence two to twelve years after parietal cell vagotomy for duodenal ulcer.
        Surgery. 1983; 94: 802-806
        • Cargill JM
        • Peden N
        • Saunders JHB
        • Wormsley KG
        Very long-term treatment of peptic ulcer with cimetidine.
        Lancet. 1978; II: 1113-1115
        • Gudmand-Hoyer E
        • Jensen KB
        • Krag E
        • et al.
        Prophylactic effect of cimetidine in duodenal ulcer disease.
        Br Med J. 1978; 1: 1095-1097
        • Boyd EJS
        • Wilson JA
        • Wormsley KG
        Safety of ranitidine maintenance treatment of duodenal ulcer.
        Scand J Gastroenterol. 1984; 19: 394-400
        • Elashoff JD
        • Van Deventer G
        • Reedy TJ
        • et al.
        Long-term follow-up of duodenal ulcer patients.
        J Clin Gastroenterol. 1983; 5: 509-515
        • Jensen RT
        • Pandol SJ
        • Collen MJ
        • Raufman JP
        • Gardner JD
        Diagnosis and management of the Zollinger-Ellison Syndrome.
        J Clin Gastroenterol. 1983; 5: 123-131
        • Malagelada JR
        • Edis AJ
        • Adson MA
        • Von Heerdon JA
        • Go VLW
        Medical and surgical options in the management of patients with gastrinoma.
        Gastroenterology. 1983; 84: 1524-1532
        • Deveney CW
        • Stein S
        • Way LW
        Cimetidine in the treatment of Zollinger-Ellison syndrome.
        Am J Surg. 1985; 146: 116-123
        • Powell JR
        • Donn KH
        Histamine H2-antagonist drug interactions in perspective: mechanistic concepts and clinical implications.
        Am J Med. 1984; 77: 57-84
        • Griffin JW
        • May JR
        • Dipiro JT
        Drug interactions: theory versus practice.
        Am J Med. 1984; 77: 85-89