Cost-Effectiveness and Cost-Utility of Long-Term Management Strategies for Heartburn

Jul 1, 2002, 00:00
10.1046/j.1524-4733.2002.54145.x
https://www.valueinhealthjournal.com/article/S1098-3015(10)60022-8/fulltext
Title : Cost-Effectiveness and Cost-Utility of Long-Term Management Strategies for Heartburn
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(10)60022-8&doi=10.1046/j.1524-4733.2002.54145.x
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Open access? : No
Section Order : 2

Objectives

To compare the expected costs and outcomes of seven alternative long-term primary care strategies for the management of patients with moderate-to-severe heartburn over a 1-year period.

Methods

A decision-analytic model was developed to estimate costs and effects (weeks with heartburn symptoms and quality adjusted life years QALYs]) for each strategy. Meta-analyses were used to synthesize acute treatment and maintenance studies and physician surveys to collect information on patient management. The impact of uncertainty on the base case results was assessed using probabilistic sensitivity analysis. Probability distributions were defined for key model parameters and techniques of Monte Carlo simulation were used to draw values from these distributions. Cost-effectiveness acceptability curves (CEACs) conditional on the monetary value decision makers are willing to pay for a symptom-free day or QALY were created for each strategy.

Results

In the base case, no strategy was strictly dominated by any other strategy. However, two strategies (maintenance H -receptor antagonists H RA] and step-down proton pump inhibitor PPI]) were dominated through principles of extended dominance. The least costly and least effective strategy was intermittent H RA, while maintenance PPI was the most costly and most effective.

Conclusions

This analysis showed that the best way of managing patients with heartburn depends on how much society is willing to pay to achieve health improvements. Based on the commonly quoted threshold of $50,000 per QALY, the optimal primary care strategy for managing patients with moderate-to-severe heartburn symptoms is to treat the symptoms with a PPI followed by maintenance therapy with an H RA to prevent symptomatic recurrence.

Categories :
  • Cost/Cost of Illness/Resource Use Studies
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Economic Evaluation
  • Gastrointestinal Disorders
  • Meta-Analysis & Indirect Comparisons
  • Methodological & Statistical Research
  • Modeling and simulation
  • Specific Diseases & Conditions
  • Study Approaches
  • Surveys & Expert Panels
Tags :
  • cost-effectiveness analysis
  • cost-utility analysis
  • economic evaluation
  • heartburn
Regions :
  • North America
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