Cost effectiveness of medical versus surgical treatment in patients with severe or refractory gastroesophageal reflux disease in the Netherlands.
BACKGROUND
For a significant number of patients with severe or refractory gastroesophageal reflux disease, maintenance treatment with omeprazole and reflux surgery (Nissen fundoplication) are alternative treatment options. In this study maintenance treatment with omeprazole is compared with open and laparoscopic Nissen fundoplication from a health-economic perspective.


METHODS
Meta-analysis of published articles to assess effectiveness and simple decision-analytic techniques to combine costs and effects are used. Findings and assumptions are submitted to sensitivity analysis.


RESULTS
It is estimated that it costs approximately 1880 Dutch guilders to initially heal a patient with severe or refractory esophagitis with 40 mg omeprazole daily. When medical maintenance therapy was compared with surgery, it appeared that medical maintenance therapy with omeprazole (20-40 mg daily) for a prolonged period of time (more than 4 years) is less cost effective than a Nissen procedure. It is estimated that a laparoscopic Nissen will shift this so-called break-even point towards 1.4 years, mainly due to a shorter hospital stay.


CONCLUSIONS
Although caution is required in drawing conclusions, it appears that replacing treatment with (laparoscopic) Nissen fundoplications in these patients might lead to substantial savings.
Van Den Boom
G
G
Dept. of Health Economics, University of Limburg, Maastricht, Netherlands.
Go
P M
PM
Hameeteman
W
W
Dallemagne
B
B
Ament
A J
AJ
D000897:Anti-Ulcer Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018662:Fundoplication / Q000191:economics* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000191:economics* / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D009426:Netherlands; D009853:Omeprazole / Q000191:economics* / Q000627:therapeutic use*; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D009853:Omeprazole