Costs of Treating Bleeding and Perforated Peptic Ulcers in The Netherlands

HELENA T.J.I. DE LEEST, HISKE E.M. VAN DIETEN, MAURITS W. VAN TULDER, WILLEM F. LEMS, BEN A.C. DIJKMANS, and MAARTEN BOERS

ABSTRACT.

Objective. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs includes perforations and bleeds. Several preventive strategies are being tested for cost-effectiveness, but little is known about the costs of the complications they are trying to prevent. We estimated the direct costs of hospital treatment of bleeding and perforated ulcers in a university hospital, from data in discharge letters and the hospital management information system.

Methods. Eligible patients had been treated in the VU University Medical Center between January 1997 and August 2000 for an ulcer bleed or perforation (International Classification of Diseases code 531–4). Resource use comprised hospitalization days and diagnostic and therapeutic interventions. Insurance claim prices determined the costs from the payers' perspective. In a secondary analysis we excluded resource use that was clearly related to the treatment of comorbid illness.

Results. Fifty-three patients with a bleeding (n = 35) or perforated ulcer (n = 15) or both (n = 3) were studied, including 14 with comorbidity; 22 complications occurred in the stomach, 29 in the duodenum, one in both stomach and duodenum, and one after partial gastrectomy. A simultaneous bleed and perforation was most expensive (€ 26,000), followed by perforation (€19,000) and bleeding (€12,000). A bleed in the duodenum was more expensive than in the stomach (€ 13,000 vs € 10,000), while the opposite was seen for perforations (€ 13,000 vs € 21,000). Comorbidity increased costs substantially: even after correction for procedures unrelated to the ulcer complication, comorbidity more than doubled the costs of treatment.

Conclusion. Treatment of complicated ulcers is expensive, especially in patients with comorbid conditions. (J Rheumatol 2004;31:788-91)

Key Indexing Terms:

COSTS
COST ANALYSIS
PEPTIC ULCER PERFORATION
PEPTIC ULCER HEMORRHAGE

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From the Department of Clinical Epidemiology and Biostatistics and the Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.

H.T.J.I. de Leest, MD; W.F. Lems, MD, PhD; B.A.C. Dijkmans, MD, PhD, Department of Rheumatology; H.E.M. van Dieten, MSc; M.W. van Tulder, PhD; M. Boers, MD, PhD, Department of Clinical Epidemiology and Biostatistics.

Address reprint requests to Dr. H. de Leest, VU University Medical Center, PO Box 7057, Room 4A42, 1007 MB Amsterdam, The Netherlands. E-mail: M.deleest@vumc.nl

Submitted November 21, 2002; revision accepted October 20, 2003.

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