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- Title
Re-examination of the Cost-Effectiveness of SurgicalVersusMedical Therapy in Patients With Gastroesophageal Reflux Disease: The Value of Long-Term Data Collection.
- Authors
Arguedas, Miguel R.; Heudebert, Gustavo R.; Klapow, Joshua C.; Centor, Robert M.; Eloubeidi, Mohamad A.; Wilcox, C. Mel; Spechler, Stuart Jon
- Abstract
OBJECTIVES: For patients with reflux esophagitis, long-term therapeutic options include proton pump inhibitor (PPI) therapy and/or antireflux surgery. An earlier cost-effectiveness analysis concluded that at 5 yr, medical therapy was less expensive but similarly effective to fundoplication, but the results were sensitive to estimates on quality of life and long-term medication usage, which were derived from“expert opinion.” Recently, data from randomized controlled trials addressing these variables have become available. We have incorporated these new data into a revised Markov model to examine the cost-effectiveness of surgicalversusmedical therapy in patients with severe reflux esophagitis.METHODS: A Markov simulation model was constructed using specialized software (DATA PRO 4.0, Williamstown, MA). Total expected costs and quality-adjusted life-years were calculated for long-term medical therapy and for laparoscopic Nissen fundoplication. Probabilities were obtained from the medical literature using Medline®. Procedural and hospitalization costs used were the average Medicare reimbursements at our institution. Medication costs were the average wholesale price. The analysis was extended over a 10-yr time horizon at a discount rate of 3%.RESULTS: The discounted analysis shows that medical therapy is associated with total costs of$8,798 and 4.59 quality-adjusted life-years, whereas the surgical strategy is more expensive ($10,475) and less effective (4.55 quality-adjusted life-years). The results were robust to most one-way sensitivity analyses.CONCLUSIONS: Long-term medical therapy with proton pump inhibitors is the preferred strategy for patients with gastroesophageal reflux disease and severe esophagitis. Our study highlights the importance of using primary, patient-derived data rather than expert opinion.
- Subjects
GASTROESOPHAGEAL reflux; ESOPHAGUS diseases; THERAPEUTICS; MEDICAL care costs; GASTROENTEROLOGY; MEDICAL research
- Publication
American Journal of Gastroenterology (Springer Nature), 2004, Vol 99, Issue 6, p1023
- ISSN
0002-9270
- Publication type
Article
- DOI
10.1111/j.1572-0241.2004.30891.x