1. The Cost-Effectiveness and Budget Impact of Intravenous Versus Oral Proton Pump Inhibitors in Peptic Ulcer Hemorrhage 
Brennan M.R. Spiegel, Gareth S. Dulai, Brian S. Lim, Neel Mann, Fasiha Kanwal, Ian M. Gralnek 
Clinical Gastroenterology and Hepatology 
Volume 4, Issue 8, Pages e2 (August 2006)
DOI: /j.cgh
Copyright © 2006 American Gastroenterological Association Terms and Conditions

2. Figure 1
Truncated depiction of decision tree. Patients are entered into the model after achieving endoscopic hemostasis, and subsequently receive either PO PPI therapy, IV PPI therapy, or IV H2RA therapy. In all arms, patients either develop recurrent hemorrhage during their inpatient stay, or do not. Patients with recurrent hemorrhage receive repeat upper endoscopy with attempted hemostasis, and patients with persistent bleeding are referred for emergent surgery. Patients achieving hemostasis are discharged on a course of outpatient PO PPI therapy. Patients also may develop recurrent hemorrhage after discharge (not shown). Refer to the Technical Appendix for all the assumptions governing the model, including branch points not shown in this truncated version of the full tree.
Clinical Gastroenterology and Hepatology 2006 4, e2DOI: ( /j.cgh )
Copyright © 2006 American Gastroenterological Association Terms and Conditions

3. Figure 2
Results of base-case cost-effectiveness analysis. The vertical axis displays the cumulative cost, and the horizontal axis displays the QALYs gained. The line connecting the IV and PO PPI strategies portrays the incremental cost-effectiveness ratio (ICER), which is $708,735 per QALY gained (slope of line). In other words, if a health plan chose to use IV PPI therapy instead of PO PPI therapy, then it would cost an incremental $708,735 per additional QALY gained. Refer to Table 4 to compare this incremental cost with incremental costs of other interventions in medicine. •, PO PPI strategy; , IV PPI strategy; ▴, H2RA strategy.
Clinical Gastroenterology and Hepatology 2006 4, e2DOI: ( /j.cgh )
Copyright © 2006 American Gastroenterological Association Terms and Conditions

4. Figure 3
Probabilistic sensitivity analysis using 2000 trials. This analysis simultaneously varies all parameters over the full range of plausible values. Each point represents the incremental cost-effectiveness ratio generated by 1 trial through the simulation. The bold line delineates the median incremental cost-effectiveness ratio of $708,735 per additional QALY gained and, by definition, 50% of the trials fall on either side of the line. The remaining 3 diagonal lines represent willingness-to-pay thresholds. Points below and to the right of each line represent patients that generated an incremental cost-effectiveness ratio below the specified threshold. For example, if a third-party payer were willing to pay $50,000 per QALY gained to use IV instead of PO PPI therapy (lowest vertical broken line), then only 8% of the patients would fall within the budget.
Clinical Gastroenterology and Hepatology 2006 4, e2DOI: ( /j.cgh )
Copyright © 2006 American Gastroenterological Association Terms and Conditions