OBJECTIVE: To compare the expected costs and outcomes of alternative strategies for the management of patients with erosive oesophagitis. DESIGN: There were 3 components to the overall analytic approach. First, a decision model was constructed to compare expected costs and outcomes of 6 management strategies. Second, principles of quantitative literature review and meta-analysis were used to determine probabilities of clinical events (i.e. oesophagitis healing and recurrence). Finally, principles of cost-effectiveness analysis were used to compare treatment alternatives in terms of dominance and incremental cost effectiveness. The viewpoint for the study was that of a provincial government payer for healthcare over a 1-year period. MAIN OUTCOME MEASURES AND RESULTS: Healing rates were significantly higher for proton pump inhibitors (PPI) [p < 0.001]. Recurrence rates were significantly higher for intermittent therapy (placebo) and lower for regular dose PPI (p < 0.001). Maintenance prokinetic agent (PA) is dominated (i.e. more costly and less effective) and step-down maintenance PPI is dominated through principles of extended dominance. The 'efficient frontier' is represented by: maintenance H2-receptor antagonist (H2RA), intermittent PPI, step-down maintenance H2RA and maintenance PPI. CONCLUSIONS: The price of H2RA is a key factor influencing whether step-down maintenance PPI forms part of, or is contained within, the 'efficient frontier' of long term management for erosive oesophagitis.
OBJECTIVE: To compare the expected costs and outcomes of alternative strategies for the management of patients with erosive oesophagitis. DESIGN: There were 3 components to the overall analytic approach. First, a decision model was constructed to compare expected costs and outcomes of 6 management strategies. Second, principles of quantitative literature review and meta-analysis were used to determine probabilities of clinical events (i.e. oesophagitis healing and recurrence). Finally, principles of cost-effectiveness analysis were used to compare treatment alternatives in terms of dominance and incremental cost effectiveness. The viewpoint for the study was that of a provincial government payer for healthcare over a 1-year period. MAIN OUTCOME MEASURES AND RESULTS: Healing rates were significantly higher for proton pump inhibitors (PPI) [p < 0.001]. Recurrence rates were significantly higher for intermittent therapy (placebo) and lower for regular dose PPI (p < 0.001). Maintenance prokinetic agent (PA) is dominated (i.e. more costly and less effective) and step-down maintenance PPI is dominated through principles of extended dominance. The 'efficient frontier' is represented by: maintenance H2-receptor antagonist (H2RA), intermittent PPI, step-down maintenance H2RA and maintenance PPI. CONCLUSIONS: The price of H2RA is a key factor influencing whether step-down maintenance PPI forms part of, or is contained within, the 'efficient frontier' of long term management for erosive oesophagitis.
Authors: A Maleev; A Mendizova; P Popov; V Vlahov; B Dimitrov; A Mihova; J Crowe; J Silveira; A Thomson; G Routhier Journal: Hepatogastroenterology Date: 1990-08
Authors: S J Sontag; D G Kogut; R Fleischmann; D R Campbell; J Richter; M Robinson; M McFarland; S Sabesin; G A Lehman; D Castell Journal: Am J Gastroenterol Date: 1997-03 Impact factor: 10.864
Authors: Alan N Barkun; Ralph Crott; Carlo A Fallone; Wendy A Kennedy; Jean Lachaine; Carey Levinton; David Armstrong; Naoki Chiba; Alan Thomson; Sander Veldhuyzen van Zanten; Paul Sinclair; Sergio Escobedo; Bijan Chakraborty; Sandra Smyth; Robert White; Helen Kalra; Krista Nevin Journal: Can J Gastroenterol Date: 2010-08 Impact factor: 3.522