PMID- 15180720
OWN - NLM
STAT- MEDLINE
DCOM- 20040806
LR  - 20131121
IS  - 0002-9270 (Print)
IS  - 0002-9270 (Linking)
VI  - 99
IP  - 6
DP  - 2004 Jun
TI  - Re-examination of the cost-effectiveness of surgical versus medical therapy in 
      patients with gastroesophageal reflux disease: the value of long-term data 
      collection.
PG  - 1023-8
AB  - 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 
      surgical versus medical 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 dollars and 4.59 quality-adjusted 
      life-years, whereas the surgical strategy is more expensive (10,475 dollars) 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.
FAU - Arguedas, Miguel R
AU  - Arguedas MR
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, University 
      of Alabama at Birmingham, Birmingham, Alabama, USA.
FAU - Heudebert, Gustavo R
AU  - Heudebert GR
FAU - Klapow, Joshua C
AU  - Klapow JC
FAU - Centor, Robert M
AU  - Centor RM
FAU - Eloubeidi, Mohamad A
AU  - Eloubeidi MA
FAU - Wilcox, C Mel
AU  - Wilcox CM
FAU - Spechler, Stuart Jon
AU  - Spechler SJ
CN  - VA Cooperative Study Group
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Enzyme Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Proton Pumps)
SB  - IM
MH  - Analysis of Variance
MH  - Cost-Benefit Analysis
MH  - Enzyme Inhibitors/*economics/therapeutic use
MH  - Female
MH  - Fundoplication/*economics
MH  - Gastroesophageal Reflux/*drug therapy/economics/mortality/*surgery
MH  - *Health Care Costs
MH  - Humans
MH  - Male
MH  - Markov Chains
MH  - Probability
MH  - Proton Pump Inhibitors
MH  - Proton Pumps/economics
MH  - *Quality-Adjusted Life Years
MH  - Registries
MH  - Severity of Illness Index
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2004/06/08 05:00
MHDA- 2004/08/07 05:00
CRDT- 2004/06/08 05:00
PHST- 2004/06/08 05:00 [pubmed]
PHST- 2004/08/07 05:00 [medline]
PHST- 2004/06/08 05:00 [entrez]
AID - AJG30891 [pii]
AID - 10.1111/j.1572-0241.2004.30891.x [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2004 Jun;99(6):1023-8. doi: 10.1111/j.1572-0241.2004.30891.x.