Gastroesophageal reflux disease is a common problem. Most patients with ero
sive GERD require long-term treatment, without which relapse is common. The
cost of ongoing medical care for GERD is substantial, and patients with sy
mptomatic GERD have impaired quality of life. Treatment strategies for GERD
should aim to improve patient outcome at a reasonable cost. Cost-effective
ness methodology facilitates the integration of costs and patient outcomes,
enabling the clinician to choose the most cost-effective therapy in a vari
ety of clinical circumstances.
The published studies reviewed in this paper show that proton pump inhibito
rs are the most cost-effective initial and maintenance medical therapy for
GERD under most circumstances. However, variations in drug acquisition cost
s, such as may occur in managed care practice settings, may lead to H2-rece
ptor antagonists being preferred under some circumstances. Tn the long-term
management of GERD, laparoscopic surgery is effective, but its high initia
l cost makes it less cost-effective than proton pump inhibitors in the earl
y treatment years. Also, recent data suggest that the long-term morbidity i
s higher than previously suspected. Finally, appropriate application of cos
t-effectiveness analyses to clinical practice requires critical appraisal o
f model design and the perspective adopted.
The purpose of this article is to describe the interpretation and applicati
on of the results of cost-effectiveness analyses in clinical practice, and
to examine the published literature on the cost-effectiveness of treatment
options for GERD. (C) 2000 by Am. Coll. of Gastroenterology.