Low-cost pantoprazole improves outcomes, reduces ICU stay, study finds

A study led by McMaster University researchers shows that a widely available and inexpensive medication not only prevents potentially serious stomach bleeding in critically ill patients, but also saves hospitals thousands of dollars. 

Published in JAMA Network Open on Dec. 1, 2025, the study is the first to demonstrate the economic benefits of the medication, pantoprazole, when prescribed in hospital for mechanically ventilated patients in the intensive care unit (ICU). These patients on life support are at high risk of upper gastrointestinal bleeding, a complication caused by stress-induced ulcers in the stomach that can prolong hospital stays and increase costs. 

In an era of rising health-care costs, interventions that are both clinically effective and cost-saving are rare. Pantoprazole checks both boxes."

Feng Xie, Professor, Department of Health Research Methods, Evidence and Impact, McMaster University

The findings build on the landmark Re-evaluating the Inhibition of Stress Erosions (REVISE) Trial led by McMaster, which established pantoprazole's clinical effectiveness in preventing bleeding. The trial was run in 68 centres in eight countries and over 4,800 patients were enrolled. 

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. 

"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 practising at St. Joseph's Healthcare Hamilton. 

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.