Pantoprazole Proves Cost-Effective for Stress Ulcer Prophylaxis in Ventilated ICU Patients: JAMA
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According to an economic analysis of the REVISE trial, IV pantoprazole, previously proven to reduce clinically significant upper GI bleeding in critically ill adults on invasive ventilation, was also cost-saving compared with placebo. The cost benefits resulted from fewer bleeding events and shorter hospital and ICU stays, confirming pantoprazole as a cost-effective option for stress ulcer prophylaxis. The study was published in JAMA Network Open by Feng X. and colleagues.
This economic evaluation was performed from a public health care payer perspective and assessed resource utilization from ICU admission until hospital discharge or death. Participants were randomized to receive either daily intravenous pantoprazole 40 mg or placebo (0.9% sodium chloride). All cost calculations were standardized to 2025 US dollars, and Canadian cost weights were applied across global sites for consistency. Sensitivity analyses used US-based cost estimates to evaluate robustness. Resource use included ICU days, hospital ward days, and all bleeding-related interventions. Uncertainty was quantified using nonparametric bootstrapping simulations, and multiple scenario analyses excluded patients in the top 10% of total resource consumption to test the stability of the findings.
Results
• The study enrolled 4821 invasively ventilated patients, with a mean (SD) age of 58.2 (16.4) years, including 1752 women (36.3%).
• Patients receiving pantoprazole experienced a mean (SD) ICU stay of 12.4 (11.7) days, compared with 13.3 (13.3) days in the no-pantoprazole group.
• Hospital length of stay averaged 14.8 (28.0) days with pantoprazole vs 16.5 (42.9) days without.
• Mean (SD) total per-patient costs were $60,466 ($58,546) with pantoprazole and $65,423 ($75,661) without, yielding an incremental cost difference of −$4957 (95% CI, −$8777 to −$1136) favouring pantoprazole. In the US-cost sensitivity analysis, total costs were $130,179 ($123,456) vs $140,770 ($153,195), producing an incremental cost difference of −$10,591 (95% CI, −$18,448 to −$2735).
• Excluding extreme high-resource patients (top 10%) produced incremental costs of −$1151 for ICU days, −$3388 for hospital ward days, and −$1356 for total costs.
• Across 99% of bootstrapped simulations, pantoprazole remained both more effective and less costly.
This economic evaluation demonstrated that, for invasively mechanically ventilated adults, daily intravenous pantoprazole is both less costly and more effective than no pantoprazole, thus confirming its value to prevent clinically important upper gastrointestinal bleeding during critical illness. The reliable cost savings, shorter hospital stay, and high probability of economic benefit support pantoprazole as an excellent option in ICU prophylactic protocols from both the clinical and health system standpoints.
Reference:
Xie F, Yao Y, Ma Y, et al. Cost-Effectiveness of Pantoprazole to Prevent Upper Gastrointestinal Bleeding in Mechanically Ventilated Patients. JAMA Netw Open. 2025;8(12):e2552771. doi:10.1001/jamanetworkopen.2025.52771
