English, Article edition: Economic Evaluation of Long Term Management Strategies for Erosive Oesophagitis Ron Goeree; Bernie O'Brien; Richard Hunt; ...

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Bookmark: http://trove.nla.gov.au/version/93712
Physical Description
  • article
Language
  • English

Edition details

Title
  • Economic Evaluation of Long Term Management Strategies for Erosive Oesophagitis
Author
  • Ron Goeree
  • Bernie O'Brien
  • Richard Hunt
  • Gordon Blackhouse
  • Andrew Willan
  • Jan Watson
Physical Description
  • article
Notes
  • Objective: To compare the expected costs and outcomes of alternative strategies for the management of patients with erosive oesophagitis. Design: 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. Main outcome measures and results: 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. Conclusions: 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.
  • Pharmacoeconomics, Reflux-oesophagitis, H2-antagonists, Proton-pump-inhibitors, Gastrokinetics, Cost-effectiveness
  • RePEc:wkh:phecon:v:16:y:1999:i:6:p:679-697
Language
  • English
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