Document Detail


Relative effectiveness and costs of antiulcer medications as a basis for rational prescribing.
MedLine Citation:
PMID:  2886896     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To be maximally effective, antiulcer medications should relieve ulcer symptoms rapidly and promote rapid healing of an ulcer crater; after the cessation of a course of treatment the ulcer should not recur. A wide variety of agents is available. These are of similar efficiency in the control of ulcer symptoms and in the acceleration of the healing of the ulcer crater. However, evidence exists of differences in the rate of the recurrence of duodenal ulcers on the cessation of these drugs. Surface-active agents (bismuth complexes, sucralfate, prostaglandins and carbenoxolone) are consistently superior to H2-histamine receptor antagonist drugs (cimetidine and ranitidine). A high relapse rate produces more patients with active disease at any one time, hence more patients will be exposed to the complications of the disease, and will require active investigation and therapy. Because of the increased rate of relapse, the use of H2-receptor antagonist drugs as first-line intermittent healing therapy can be shown to be associated with an eight-fold (800%) increase in cost of pharmaceutical agents as compared with first-line treatment with bismuth salts; a four-fold increase compared with the cost of using antacid drugs; and a two-fold increase compared with the cost of using sucralfate. When maintenance therapy with H2-receptor antagonist agents is given instead of intermittent therapy with bismuth complexes, a 14-fold increase in pharmaceutical costs is incurred, with inferior results that have already been demonstrated under the conditions of a controlled clinical trial. These considerations of efficacy and cost suggest that H2-receptor antagonist drugs ought not to be first-line therapy for duodenal ulcers; rather, surface-active agents such as colloidal bismuth or sucralfate should be prescribed initially.
Authors:
A J McLean; D M Harcourt; P G McCarthy; F J Dudley; J J McNeil
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  146     ISSN:  0025-729X     ISO Abbreviation:  Med. J. Aust.     Publication Date:  1987 Apr 
Date Detail:
Created Date:  1987-09-24     Completed Date:  1987-09-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  AUSTRALIA    
Other Details:
Languages:  eng     Pagination:  431-3, 436-8, 442     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Antacids / pharmacology,  therapeutic use
Anti-Ulcer Agents / pharmacology*,  therapeutic use
Costs and Cost Analysis
Histamine H2 Antagonists / pharmacology,  therapeutic use
Humans
Organometallic Compounds / pharmacology,  therapeutic use
Peptic Ulcer / drug therapy*,  economics,  physiopathology
Recurrence
Chemical
Reg. No./Substance:
0/Antacids; 0/Anti-Ulcer Agents; 0/Histamine H2 Antagonists; 0/Organometallic Compounds; 57644-54-9/bismuth tripotassium dicitrate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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