Omeprazole or ranitidine plus metoclopramide for patients with severe erosive oesophagitis. A cost-effectiveness analysis.
The objective of this study was to evaluate the clinical and economic effects of 2 clinical strategies for treating severe (grade II and above) erosive oesophagitis or poorly responsive gastro-oesophageal reflux disease. A single-blind, randomised controlled trial of up to 8 weeks' duration was undertaken comparing omeprazole with ranitidine plus metoclopramide in patients with severe and symptomatic erosive oesophagitis (endoscopic grade II and above). Two cost-effectiveness ratios were calculated: cost per healed patient and cost per symptom-free day. The study perspective was that of the payer or insurer of medical care. Healing rates were significantly higher among omeprazole-treated patients than among those who received ranitidine/metoclopramide at 4 weeks (68.5% vs 30.4%; p < 0.01) and overall (81.5% vs 45.7%; p < 0.01). Overall, mean gastrointestinal-related direct medical costs per healed patient were lower for the omeprazole group ($US189.60) than for the ranitidine/metoclopramide group ($US319.28). The incremental cost of an additional cure with omeprazole compared with ranitidine/metoclopramide was $US24.05. The overall average cost per symptom-free day was lower in the omeprazole group ($US7.88) than in the ranitidine/metoclopramide group ($US10.81). The incremental cost to obtain an additional symptom-free day with omeprazole, compared with ranitidine/metoclopramide, was $US1.41. In conclusion, superior efficacy at comparable cost is achieved by omeprazole compared with ranitidine/metoclopramide in the treatment of patients with severe erosive oesophagitis.
Bloom
B S
BS
University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, USA.
Hillman
A L
AL
LaMont
B
B
Liss
C
C
Schwartz
J S
JS
Stever
G J
GJ
D000897:Anti-Ulcer Agents / Q000191:economics* / Q000627:therapeutic use*; D000932:Antiemetics / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004338:Drug Combinations; D004941:Esophagitis / Q000188:drug therapy* / Q000191:economics*; D004945:Esophagoscopy; D006801:Humans; D008787:Metoclopramide / Q000191:economics* / Q000627:therapeutic use*; D009853:Omeprazole / Q000191:economics* / Q000627:therapeutic use*; D011446:Prospective Studies; D011899:Ranitidine / Q000191:economics* / Q000627:therapeutic use*