Medical treatment of gastroesophageal reflux disease in the managed care environment.

The goals of management of any disease process (ie, to relieve symptoms, heal the process, and prevent complications while minimizing the use of health care resources), including gastroesophageal reflux disease (GERD), are not altered by practicing within a managed care environment. However, short-sightedness sometimes leads one to view outcomes from a narrow focus (costs of treatments, diagnostic tests, etc) instead of evaluating overall cost and outcome. GERD is an example in which short-sighted approaches (using cheaper but less effective pharmaceutical agents) have led to worse outcomes and more costly therapy. A therapy that is less costly but also less effective in preventing symptoms and complications is more expensive than a therapy that costs more but keeps a patient in remission. "The most expensive therapy is the one that doesn't work." These simple, underutilized, pharmacoeconomic concepts are the basis for the discussion of GERD and the suggested treatment algorithm that follows.