Cost and quality effects of treating erosive oesophagitis. A re-evaluation.
The objective of this study was to re-evaluate the clinical and economic effects of common therapies for erosive oesophagitis in the light of a newly approved treatment regimen. A previously constructed 7-month community practice decision analytical model was revised to include the latest published data on efficacy and symptomatic outcomes. The original results of phase I therapy (antacids plus dietary, sleeping and lifestyle changes) alone or combined with ranitidine 150mg bid or omeprazole 20mg od were reassessed by adding new clinical data on the efficacy of and symptomatic response to ranitidine 150mg qid. The same payment data used in the first analysis were applied here as well, with the addition of the US price of ranitidine 150mg qid. The study perspective was that of the payer or insurer. Omeprazole-based therapy remained a dominant strategy for symptomatic care during the 7-month model. It was 14% less costly per patient, led to 23% fewer symptomatic months, and had 21% lower cost per symptom-free month than ranitidine 150mg qid, the next best alternative. Evolving treatment strategies necessitate rapid assessment and reassessment so that clinical practice can remain current, patients can be assured of the best quality, and insurers can be aware of treatment cost and budgetary impact given limited resources in all countries. Only by consistent and continuous re-evaluation of new or changing medical interventions can clinicians and insurers adapt patient management to new scientifically derived results. This is the best manner by which to meet patients' care needs and the clinical needs of practitioners, as well as the financial needs of payers.
Bloom
B S
BS
University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, USA.
D000863:Antacids / Q000191:economics / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000191:economics* / Q000627:therapeutic use*; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003663:Decision Trees; D004942:Esophagitis, Peptic / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D007348:Insurance, Health; D009853:Omeprazole / Q000191:economics / Q000627:therapeutic use; D011899:Ranitidine / Q000191:economics* / Q000627:therapeutic use*; D016896:Treatment Outcome