OMEPRAZOLE OR RANITIDINE PLUS METOCLOPRAMIDE FOR PATIENTS WITH SEVEREEROSIVE ESOPHAGITIS - A COST-EFFECTIVENESS ANALYSIS

The objective of this study was to evaluate the clinical and economic effects of 2 clinical strategies for treating severe (grade II and abo ve) erosive oesophagitis or poorly responsive gastro-oesophageal reflu x disease. A single-blind, randomised controlled trial of up to 8 week s' duration was undertaken comparing omeprazole with ranitidine plus m etoclopramide in patients with severe and symptomatic erosive oesophag itis (endoscopic grade II and above). Two cost-effectiveness ratios we re calculated: cost per healed patient and cost per symptom-free day. The study perspective was that of the payer or insurer of medical care . Healing rates were significantly higher among omeprazole-treated pat ients than among those who received ranitidine/metoclopramide de at 4 weeks (68.5% vs 30.4%; p < 0.01) and overall (81.5% vs 45.7%; p < 0.01 ). Overall, mean gastrointestinal-related direct medical costs per hea led patient were lower for the omeprazole group ($US189.60) than for t he ranitidine/metoclopramide group ($US319.28). The incremental cost o f an additional cure with omeprazole compared with ranitidine/metoclop ramide was $US24.05. The overall average cost per symptom-free day was lower in the omeprazole group ($US7.88) than in the ranitidine/metocl opramide group ($US10.81). The incremental cost to obtain an additiona l symptom-free day with omeprazole, compared with ranitidine/metoclopr amide, was $US1.41. In conclusion, superior efficacy at comparable cos t is achieved by omeprazole compared with ranitidine/metoclopramide in the treatment of patients with severe erosive oesophagitis.