Choice of long-term strategy for the management of patients with severe esophagitis: a cost-utility analysis.
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.
Heudebert
G R
GR
Department of Medicine, Birmingham Veterans Administration Medical Center, and University of Alabama at Birmingham, 35294-3296, USA. gheudebert@gim.dom.uab.edu
Marks
R
R
Wilcox
C M
CM
Centor
R M
RM
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
D009853:Omeprazole