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Relative effectiveness and costs of antiulcer medications as a basis for rational prescribing
Author(s) -
McLean Allan J.,
Harcourt Diana M.,
McCarthy Peter G.,
Dudley Frank J.,
McNeil John J.
Publication year - 1987
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1987.tb120338.x
Subject(s) - sucralfate , antiulcer drug , cimetidine , medicine , antacid , ranitidine , drug , antagonist , pharmacology , receptor
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 H 2 ‐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 H 2 ‐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 H 2 ‐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 H 2 ‐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.