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- Title
Economic evaluation of long-term management strategies for erosive oesophagitis.
- Authors
Goeree, R.; O'Brien, B.; Hunt, R.; Blackhouse, G.; Willan, A.; Watson, J.
- Abstract
<bold>Objective: </bold>To compare the expected costs and outcomes of alternative strategies for the management of patients with erosive oesophagitis.<bold>Design: </bold>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.<bold>Main Outcome Measures and Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
ESOPHAGUS diseases; PATIENTS; META-analysis; MEDICAL care; PROTON pump inhibitors; COMPARATIVE studies; GASTROINTESTINAL agents; LONG-term health care; RESEARCH methodology; MEDICAL cooperation; RESEARCH; COST analysis; EVALUATION research; TREATMENT effectiveness; THERAPEUTICS
- Publication
PharmacoEconomics, 1999, Vol 16, Issue 6, p679
- ISSN
1170-7690
- Publication type
journal article
- DOI
10.2165/00019053-199916060-00007