What is heartburn worth? A cost-utility analysis of management strategies.
OBJECTIVE
To determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn.


METHODS
We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine2-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice.


RESULTS
Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine2 receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine2-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative.


CONCLUSIONS
Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine2-receptor antagonist depends on the impact of heartburn on quality of life.
Heudebert
G R
GR
Divisions of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-3296, USA. gheudebert@gim.meb.uab.edu
Centor
R M
RM
Klapow
J C
JC
Marks
R
R
Johnson
L
L
Wilcox
C M
CM
D000897:Anti-Ulcer Agents / Q000191:economics* / Q000627:therapeutic use; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003937:Diagnosis, Differential; D004064:Digestive System / Q000000981:diagnostic imaging; D019468:Disease Management; D016145:Endoscopy, Digestive System / Q000191:economics*; D006356:Heartburn / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D006635:Histamine H2 Antagonists / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D054328:Proton Pump Inhibitors; D019057:Quality-Adjusted Life Years; D011860:Radiography, Abdominal / Q000191:economics*; D012680:Sensitivity and Specificity
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors