Plumb, J.M.; Edwards, S.J.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA44
Academic Journal
Objective: To assess the cost-effectiveness of combined high and Iow dose PPI strategies using UK licensed dose for the maintenance of healed reflux oesophagitis over 12 months From the perspective of the UK NHS. Methods: A decision analysis model was constructed to depict the sequential management of the maintenance of healed reflux oesophagitis, based on a systematic review of remission rate data at 6 and 12 months. Patients relapsing at 6 months followed a healing strategy identified in a survey of UK general practitioners and gastroenterologists. Treatment strategies, in terms of high and Iow dose PPIs prescribed, were based on UK prescribing patterns. Resource units were multiplied by national published resource unit costs at 2000/01 prices. Sensitivity analyses were conducted to assess the robustness of the model. Outcome Measure: The measure of clinical effectiveness was, "the proportion of patients relapse-free for 12 months". Relapse was defined as endoscopic evidence of oesophagitis and/or symptomatic relapse. Results: Esomeprazole dominates all other PPI strategies (ie it is more effective and less costly). In terms of cost alone, the mean cost per patient treated for the esomeprazole strategy is numerically less than the lansoprazole strategy but would be considered cost-neutral (£276.61 v £279.98). However, the additional effectiveness of the esomeprazole strategy compared to the lansoprazole strategy (0.763 v 0.738) results in a lower mean cost per relapse-free patient for 12 months (£362.53 v £379.38). A sensitivity analysis indicated that the results were relatively robust to changes in key model parameters. Conclusion: Esomeprazole is the most cost-effective strategy for the maintenance of healed reflux oesophagitis over 12 months.


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