A cost-utility analysis comparing omeprazole with ranitidine in the maintenance therapy of peptic esophageal stricture.
BACKGROUND
Recent studies have suggested that patients receiving omeprazole for prophylaxis against peptic esophageal stricture recurrence have less dysphagia and require fewer repeat dilations than patients receiving ranitidine.


OBJECTIVE
To estimate the incremental utility gain and associated incremental cost of omeprazole compared with those of ranitidine for the maintenance therapy of patients with peptic stricture who required esophageal dilation.


METHODS
Decision analysis using SMLTREE software was used to compare the incremental cost-utility of omeprazole 20 mg once daily with that of ranitidine 150 mg bid for one year. Variables were estimated from the literature, hospital data, and utility analyses involving patients with peptic stricture and health professionals. The primary outcome measure was cost per quality-adjusted life-years (QALYs) gained.


RESULTS
The incremental cost of omeprazole compared with that of ranitidine was $556 per patient treated. The incremental utility gain of omeprazole was 0.0112 QALYs. Overall, the incremental cost:utility ratio of omeprazole in the maintenance therapy of patients with peptic stricture was $49,600 per QALY gained. A sensitivity analysis revealed that the estimates with the greatest impact on the cost:utility ratio were disutility associated with dysphagia and dilation, the probability of requiring redilation and the cost of medications.


CONCLUSIONS
Omeprazole 20 mg once daily is associated with greater utility and higher cost than ranitidine 150 mg bid when used as prophylaxis against stricture recurrence. Omeprazole may be considered clinically and economically sufficient enough to warrant widespread use in this setting.
Stal
J M
JM
Department of Medicine, University of Western Ontario, London.
Gregor
J C
JC
Preiksaitis
H G
HG
Reynolds
R P
RP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000191:economics* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003680:Deglutition Disorders / Q000209:etiology; D004940:Esophageal Stenosis / Q000150:complications / Q000188:drug therapy* / Q000191:economics* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D011899:Ranitidine / Q000191:economics* / Q000627:therapeutic use*; D055502:Secondary Prevention; D012720:Severity of Illness Index
D000897:Anti-Ulcer Agents; D011899:Ranitidine; D009853:Omeprazole