title: Choice of long-term strategy for the management of patients with severe esophagitis: a cost-utility analysis.
abstract: OBJECTIVE
  Omeprazole has shown remarkable efficacy and safety in the treatment of patients with gastroesophageal reflux disease (GERD); similarly, laparoscopic techniques have allowed less morbidity in patients undergoing fundoplication procedures. Concerns about the long-term cost and safety of both strategies have prompted a debate of their role in long-term management of patients with severe erosive esophagitis.
  
  
  METHODS
  A cost-utility analysis was performed to compare two strategies: laparoscopic Nissen fundoplication (LNF) vs. omeprazole. A two-stage Markov model was used to obtain cost and efficacy estimates; all estimates were discounted at 3% per year. The time horizon was 5 years. Sensitivity analyses were performed on all relevant variables.
  
  
  RESULTS
  Both strategies were similarly effective (4.33 quality-adjusted life years per patient), with omeprazole less expensive than LNF ($6053 vs. $9482 per patient). At 10 years, LNF and omeprazole costs were similar. Efficacy estimates were extremely sensitive to changes in quality of life associated with postoperative symptoms and long-term use of medication.
  
  
  CONCLUSIONS
  Medical therapy is the preferred treatment strategy for most patients with severe erosive esophagitis. Individuals with a long life expectancy are good candidates for LNF if postoperative morbidity is low and GERD symptoms remain abated for many years.
authors.affiliation: Department of Medicine, Birmingham Veterans Administration Medical Center, and University of Alabama at Birmingham, 35294-3296, USA. gheudebert@gim.dom.uab.edu
authors.forename: G R
authors.initials: GR
authors.lastname: Heudebert
authors.forename: R
authors.initials: R
authors.lastname: Marks
authors.forename: C M
authors.initials: CM
authors.lastname: Wilcox
authors.forename: R M
authors.initials: RM
authors.lastname: Centor
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004941:Esophagitis / Q000188:drug therapy* / Q000601:surgery*; D018662:Fundoplication; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D009853:Omeprazole / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009853:Omeprazole