Economic considerations in the treatment of gastroesophageal reflux disease: A review

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.