PREVENTION OF RECURRENCES OF EROSIVE REFLUX ESOPHAGITIS - A COST-EFFECTIVENESS ANALYSIS OF MAINTENANCE PROTON PUMP INHIBITION

PURPOSE: TO determine the cost-effectiveness of three management strat egies for healed erosive reflux esophagitis: maintenance therapy with a proton pump inhibitor (PPI) from the outset; no maintenance therapy unless a patient's symptoms recur once over a year; and no maintenance therapy unless a patient's symptoms recur twice over a year. MATERIAL S AND METHODS: Decision analysis using data from randomized trials of lansoprazole, case series, and expert opinion. RESULTS: For patients w ith grade 4 esophagitis, maintenance from the outset is the most effic ient approach. For all other patients, providing maintenance PPI after a patient experiences two recurrences is the least costly but least e ffective approach. The other two approaches prevent more recurrences: waiting to initiate maintenance therapy until symptoms recur once requ ires an additional $73 for each recurrence prevented whereas maintenan ce PPI from the outset requires an additional $819 for each recurrence prevented. Maintenance therapy from the outset is cost effective if s ymptoms of esophagitis cause a 22% or greater decrement in quality of life (using $50,000 per quality-adjusted life year gained as a cost-ef fectiveness definition). However, withholding maintenance until the ti me of a first recurrence is cost effective if symptoms cause a 2% or g reater decrement in quality of life. CONCLUSION: For grades 2 and 3 es ophagitis, providing maintenance therapy after a patient experiences a further recurrence is a preferred option that appears cost-effective across a wide array of assumptions. Maintenance therapy from the outse t, however, appears cost-effective only for those patients who report a significant decline in quality of life associated with esophagitis o r for those patients with baseline grade 4 esophagitis. (C) 1997 by Ex cerpta Medica, Inc.