On-demand and intermittent therapy for gastro-oesophageal reflux disease: economic considerations.
Since gastro-oesophageal reflux disease (GORD) is a prevalent condition characterised by frequent relapses, long-term costs of management for this disease are high. Thus, strategies to decrease resource expenditures without impairing patient quality of life are desirable. On-demand therapy (one-dose when symptoms occur) and intermittent therapy (short course of medication when symptoms occur) are attractive since pharmaceutical expenditures may be decreased, and many patients self-employ this strategy. The purpose of this paper was to examine the economic implications of on-demand or intermittent therapy for GORD. A review of selected studies evaluating medication suitable for on-demand or intermittent administration was performed. A complete search for published studies on the cost effectiveness of on-demand or intermittent therapy for GORD was conducted, and the results discussed in detail. Antacids, alginates, topically active agents, histamine(2)-receptor antagonists, and proton pump inhibitors have all demonstrable efficacy compared with placebo when administered on-demand. Proton pump inhibitors constitute the most effective pharmacological means to treat GORD. Although step-up strategies initially using less potent medication may decrease resource use, cost-effectiveness analysis illustrates that on-demand or intermittent therapy with proton pump inhibitors may be reasonable options. Further work that defines quality of life and patient preferences associated with GORD may allow for proper allocation of resources for the management of this condition.
VA Center for Practice Management and Outcomes Research and the University of Michigan Medical Center, Ann Arbor, Michigan 48105, USA. jinadomi@umich.edu
John M
JM
Inadomi
D000863:Antacids / Q000008:administration & dosage / Q000191:economics; D002986:Clinical Trials as Topic; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000191:economics; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000191:economics*; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000145:classification / Q000191:economics; D006635:Histamine H2 Antagonists / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D054328:Proton Pump Inhibitors; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
D000863:Antacids; D004791:Enzyme Inhibitors; D005765:Gastrointestinal Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors