Economic evaluation of long-term management strategies for erosive oesophagitis.
OBJECTIVE
To compare the expected costs and outcomes of alternative strategies for the management of patients with erosive oesophagitis.


METHODS
There were 3 components to the overall analytic approach. First, a decision model was constructed to compare expected costs and outcomes of 6 management strategies. Second, principles of quantitative literature review and meta-analysis were used to determine probabilities of clinical events (i.e. oesophagitis healing and recurrence). Finally, principles of cost-effectiveness analysis were used to compare treatment alternatives in terms of dominance and incremental cost effectiveness. The viewpoint for the study was that of a provincial government payer for healthcare over a 1-year period.


RESULTS
Healing rates were significantly higher for proton pump inhibitors (PPI) [p < 0.001]. Recurrence rates were significantly higher for intermittent therapy (placebo) and lower for regular dose PPI (p < 0.001). Maintenance prokinetic agent (PA) is dominated (i.e. more costly and less effective) and step-down maintenance PPI is dominated through principles of extended dominance. The 'efficient frontier' is represented by: maintenance H2-receptor antagonist (H2RA), intermittent PPI, step-down maintenance H2RA and maintenance PPI.


CONCLUSIONS
The price of H2RA is a key factor influencing whether step-down maintenance PPI forms part of, or is contained within, the 'efficient frontier' of long term management for erosive oesophagitis.
Goeree
R
R
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. goereer@fhs.csu.mcmaster.ca
O'Brien
B
B
Hunt
R
R
Blackhouse
G
G
Willan
A
A
Watson
J
J
D003365:Costs and Cost Analysis; D004941:Esophagitis / Q000191:economics* / Q000628:therapy*; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008134:Long-Term Care; D054328:Proton Pump Inhibitors; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors