A COST-UTILITY ANALYSIS COMPARING OMEPRAZOLE WITH RANITIDINE IN THE MAINTENANCE THERAPY OF PEPTIC ESOPHAGEAL STRICTURE

BACKGROUND: Recent studies have suggested that patients receiving omep razole for prophylaxis against peptic esophageal stricture recurrence have less dysphagia and require fewer repeat dilations than patients r eceiving ranitidine. OBJECTIVE: To estimate the incremental utility ga in and associated incremental cost of omeprazole compared with those o f ranitidine for the maintenance therapy of patients with peptic stric ture who required esophageal dilation. METHODS: Decision analysis usin g SML TREE software was used to compare the incremental cost utility o f omeprazole 20 mg once daily with that of ranitidine 150 mg bid for o ne year. Variables were estimated from the literature, hospital data, and utility analyses involving patients with peptic stricture and heal th professionals. The primary outcome measure was cost per quality-adj usted life-years (QALYs) gained. RESULTS: The incremental cost of omep razole compared with that of ranitidine was $556 per patient treated. The incremental utility gain of omeprazole was 0.0112 QALYs. Overall, the incremental cost :utility ratio of omeprazole in the maintenance t herapy of patients with peptic stricture was $49,600 per QALY gained. A sensitivity analysis revealed that the estimates with the greatest i mpact on the cost:utility ratio were disutility associated with dyspha gia and dilation, the probability of requiring redilation and the cost of medications. CONCLUSIONS: Omeprazole 20 mg once daily is associate d with greater utility and higher cost than ranitidine 150 mg bid when used as prophylaxis against stricture recurrence. Omeprazole may be c onsidered clinically and economically sufficient enough to warrant wid espread use in this setting.