CHOICE OF LONG-TERM STRATEGY FOR THE MANAGEMENT OF PATIENTS WITH SEVERE ESOPHAGITIS - A COST-UTILITY ANALYSIS

Background & Aims: Omeprazole has shown remarkable efficacy and safety in the treatment of patients with gastroesophageal reflux disease (GE RD); similarly, laparoscopic techniques have allowed less morbidity in patients undergoing fundoplication procedures. Concerns about the lon g-term cost and safety of both strategies have prompted a debate of th eir role in long-term management of patients with severe erosive esoph agitis. Methods: A cost-utility analysis was performed to compare two strategies: laparoscopic Nissen fundoplication (LNF) vs. omeprazole. A two-stage Markov model was used to obtain cost and efficacy estimates ; all estimates were discounted at 3% per year. The time horizon was 5 years. Sensitivity analyses were performed on all relevant variables. Results: Both strategies were similarly effective (4.33 quality-adjus ted life years per patient), with omeprazole less expensive than LNF ( $6053 vs. $9482 per patient). At 10 years, LNF and omeprazole costs we re similar. Efficacy estimates were extremely sensitive to changes in quality of life associated with postoperative symptoms and long-term u se of medication. Conclusions: Medical therapy is the preferred treatm ent strategy for most patients with severe erosive esophagitis. Indivi duals with a long life expectancy ave good candidates for LNF if posto perative morbidity is low and GERD symptoms remain abated for many yea rs.