A new analysis suggests that an inexpensive and widely used medication may offer unexpectedly large benefits for some of the sickest hospital patients. By reducing a serious complication linked to mechanical ventilation, the treatment may also lower overall hospital resource use. Credit: Shutterstock
New research shows that a low-cost medication can prevent serious complications in ventilated ICU patients while also saving hospitals money.
A research team from McMaster University has found that a common and low-cost medication can do more than reduce the risk of serious stomach bleeding in critically ill patients. Their work shows that using this drug can also help hospitals save thousands of dollars.
The study, published in JAMA Network Open, is the first to show the financial advantages of prescribing pantoprazole to mechanically ventilated patients in the intensive care unit (ICU). People receiving life support face a significant risk of upper gastrointestinal bleeding caused by stress-related ulcers in the stomach, a problem that can lead to longer hospital stays and higher overall expenses.
“In an era of rising health-care costs, interventions that are both clinically effective and cost-saving are rare. Pantoprazole checks both boxes,” said Feng Xie, lead author of the study and a professor in the Department of Health Research Methods, Evidence and Impact at McMaster.
Building on the REVISE Trial
These results expand on the major Re-evaluating the Inhibition of Stress Erosions (REVISE) Trial, also led by McMaster. That earlier study confirmed pantoprazole’s ability to prevent bleeding in critically ill patients. The trial included more than 4,800 participants across 68 centers in eight different countries.
Until now, the economic impact of prescribing pantoprazole each day for patients on breathing machines had been unclear. The researchers conducted a cost-effectiveness analysis using international data from the REVISE trial, comparing outcomes and resource use between patients who received pantoprazole daily and those who did not. The results have significant implications for critical care practitioners, pharmacy departments, and policymakers.
Cost Savings in High-Tech ICU Settings
“Pantoprazole costs between 50 cents and two dollars per dose across the country, yet our analysis showed how prescribing it to invasively ventilated patients can save healthcare resources by reducing bleeding events and reducing length of stay in the intensive care unit and hospital,” said senior author Deborah Cook, a professor in the Department of Medicine at McMaster.
“In the expensive, high-technology ICU setting, this is a simple, low-cost intervention that improves outcomes and reduces health-care costs,” adds Cook, a critical care physician practicing at St. Joseph’s Healthcare Hamilton.
Reference: “Cost-Effectiveness of Pantoprazole to Prevent Upper Gastrointestinal Bleeding in Mechanically Ventilated Patients” by Feng Xie, Yifan Yao, Yue Ma, Brittany Humphries, Vincent I. Lau, Robert Fowler, Bram Rochwerg, Diane Heels-Ansdell, Nicole Zytaruk, Jeffrey F. Barletta, Salmaan Kanji, Yaseen M. Arabi, Daniel W. Johnson, David Williamson, John C. Marshall, Adam Deane, John Myburgh, Anna Geagea, Alex Poole, Patrick Archambault, Kosar Khwaja, Marlies Ostermann, Lisa Burry, Gordon H. Guyatt, Deborah J. Cook, E-REVISE Collaborators and the Canadian Critical Care Trials Group, Francois Lauzier, Lois Saunders, Miranda Hardie, Waleed Alhazzani, John Muscedere, Shane English, Serena Knowles, Naomi Hammond, Kathleen M. Byrne, Marianne Chapman, Balasubramanian Venkatesh, Paul Young, Dorrilyn Rajbhandari, Abdulrahman Al-Fares, Gilmar Reis, Mobeen Iqbal, Richard Hall, Maureen Meade, Lori Hand, Erick Duan, France Clarke, Joanna Dionne, Jennifer LY Tsang, Timothy Karachi, François Lamontagne, Frederick D’Aragon, Charles St. Arnaud, Brenda Reeve, Daniel Niven, Gloria Vazquez-Grande, Ryan Zarychanski, Daniel Ovakim, Gordon Wood, Karen E.A. Burns, Alberto Goffi, M. Elizabeth Wilcox, William Henderson, David Forrest, Neill Adhikari, Ian Ball, Tina Mele, Alexandra Binnie, Sebastien Trop, Sangeeta Mehta, Ingrid Morgan, Osama Loubani, Meredith Vanstone, Kristen Fiest, Emmanuel Charbonney, Alexandros Cavayas, Oleksa Rewa, Arnold S. Kristof, Eric Sy, Brittany Dennis, Steven Reynolds, François Marquis, François Lellouche, Adam Rahman, Paul Hosek, Robert Cirone, Mark Tutschka, Laurent Billot, Lehana Thabane and Simon Finfer, , JAMA Network Open.
DOI: 10.1001/jamanetworkopen.2025.52771
This economic evaluation, E-REVISE, was funded by grants from the Hamilton Academic Health Sciences Organization and the Canadian Institutes for Health Research. The REVISE Trial was funded by the Canadian Institutes for Health Research, the Accelerating Clinical Trials Fund, Physicians Services Incorporated of Ontario, Hamilton Association of Health Sciences Organization, and the National Health Medical Research Council of Australia.
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