A low-cost medication that can be purchased for about 50 cents a dose may help hospitals save substantial money while also reducing serious complications in critically ill patients, according to new research published in JAMA Network Open.
In a large international study led by researchers at McMaster University, pantoprazole—a proton pump inhibitor commonly used to guard against stomach bleeding—was shown to offer both clinical benefits and meaningful cost savings for mechanically ventilated intensive care patients.
Pantoprazole is routinely used to prevent upper gastrointestinal bleeding in patients at high risk, including those on invasive mechanical ventilation. These patients are prone to stress-related stomach ulcers, which can trigger bleeding, prolong hospital stays, and drive up treatment expenses. The new analysis indicates that regularly giving pantoprazole to this group can lower hospital costs by several thousand dollars per patient.
The economic evaluation was conducted alongside the REVISE (Re-evaluating the Inhibition of Stress Erosions) trial, a randomized clinical study involving 4,821 critically ill adults treated in 68 intensive care units across the United States, Australia, Brazil, Canada, England, Kuwait, Pakistan, and Saudi Arabia. The average participant was 58 years old, and 36 percent were women.
Researchers compared outcomes and resource use between two groups: one that received daily intravenous pantoprazole and one that did not receive the drug. Patients were followed from ICU admission until hospital discharge, and the analysis was carried out from the perspective of a public health care payer.
Patients who received pantoprazole spent slightly less time in both the ICU and the hospital overall. Their average ICU stay was 12.4 days, compared with 13.3 days for patients who did not receive pantoprazole. Total hospital stays averaged 14.8 days in the pantoprazole group and 16.5 days in the control group.
The study found that the mean total cost per patient was $60,466 for those treated with pantoprazole, versus $65,423 for those who did not receive the drug—an estimated savings of $4,957 per patient. In 99 percent of the simulation models the team ran, pantoprazole emerged as both more effective and less costly than withholding the drug.
When the researchers applied U.S.-based cost estimates to the entire study population in a sensitivity analysis, the financial advantage became even more striking. Under that scenario, average costs were $130,179 for pantoprazole-treated patients and $140,770 for those who did not receive it, a difference of $10,591 per patient.
Even after excluding the top 10 percent of the most expensive patients—those with the highest ICU days, ward days, or overall expenditures—the pantoprazole group continued to show savings ranging from $1,151 to $3,388 per patient, depending on the metric.
These findings have direct implications for hospitals and health systems working under tight budgets. By demonstrating that pantoprazole can offer both clinical protection and financial benefits, the study provides support for wider routine use of the drug in mechanically ventilated ICU patients.
Until now, the economic value of pantoprazole in this specific setting had not been well defined. This research helps close that gap, giving clinicians, pharmacy services, and policymakers stronger evidence to guide decisions about preventive care for high-risk ICU patients.
Reference
Xie, F., Yao, Y., Ma, Y., Humphries, B., Lau, V. I., Fowler, R., Rochwerg, B., Heels-Ansdell, D., Zytaruk, N., Barletta, J. F., Kanji, S., Arabi, Y. M., Johnson, D. W., Williamson, D., Marshall, J. C., Deane, A., Myburgh, J., Geagea, A., Poole, A., Archambault, P., Khwaja, K., Ostermann, M., Burry, L., Guyatt, G. H., & Cook, D. J., for the E-REVISE Collaborators and the Canadian Critical Care Trials Group. (2025). Cost-effectiveness of pantoprazole to prevent upper gastrointestinal bleeding in mechanically ventilated patients. JAMA Network Open, 8(12). https://doi.org/10.1001/jamanetworkopen.2025.52771
