A Cost-Effectiveness Analysis of Prescribing Strategies in The Management of Gastroesophageal Reflux Disease

Gerson, Lauren B.; Robbins, Anthony; Garber, Alan M.; Hornberger, John; Triadafilopoulos, George

doi:10.1111/j.1572-0241.2000.01759.x

Cited by 107 publications

(60 citation statements)

References 67 publications

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“…Studies only including persons undergoing medical treatment must yield higher resource use and cost estimates. This is the case in most research addressing the economics of reflux disease (Viljakka et al 1997;Sonnenberg et al 1999;Gerson et al 2000). Eggleston et al (1998), e.g., refer to a period of initial medical activity.…”

Section: Choice Of Risk Scorementioning

confidence: 99%

Epidemiology and costs of gastroesophageal reflux disease in Switzerland: a population-based study

Schwenkglenks

Marbet²,

Szucs

2004

Sozial- und Pr�ventivmedizin/Social and Preventive Medicine

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SummaryObjectives: Assessment of the prevalence, health care resource use and cost of gastroesophageal reflux disease in Switzerland.Methods: A population-based telephone survey was conducted in German and French speaking Switzerland. Reflux cases were defined using a questionnaire proposed by the German Gastro League and answered additional questions on their personal characteristics and resource use. Conclusions:The prevalence of reflux disease in Switzerland is similar to that in other industrialised countries. Reflux disease causes considerable costs, in the medical system and at the societal level. Keywords: Gastroesophageal reflux -Epidemiology -Economics - Cost of illness -Switzerland.Recent studies addressing the epidemiology of oesophageal reflux disease have reported a tenfold increase in prevalence during the last 30 years (El-Serag & Sonnenberg 1998). During the same time span, reflux may have developed from a problem mainly affecting males to one being equally distributed between genders (Ter 2000). Surveys in France, Great Britain, Italy, Sweden, and Germany have shown that 18 % to 40 % of the populations of these countries suffer from reflux symptoms (Kennedy et al. 1998;Rösch & Hotz 2000). U.S. prevalence figures are in the same range (Spechler 1992;Locke et al. 1997). Quality of life studies in patients with reflux disease show these to be seriously incapacitated (Rösch & Hotz 2000). Reflux disease is associated with a risk of developing Barrett's Esophagus (BE), and of subsequently developing adenocarcinoma of the oesophagus, with a very poor prognosis (Skinner et al. 1983). The causes of the increase in reflux disease remain unclear. Environmental factors such as stress, stimulus satiation, and changes in dietary practices are discussed, as well as decreasing infection rates with Helicobacter pylori and the introduction of medications promoting reflux by relaxing the lower oesophageal sphincter (Lagergren et al. 2000). The development of proton pump inhibitors (PPIs) has revolutionised the treatment of reflux disease and the approach to BE. PPIs allow for a continuous suppression of gastric acid production, generally achieving a healing of oesophagitis (Janknegt et al. 1999). In order to avoid recurrencies, costly continued treatment with this class of substances is usually necessary (O'Connor et al. 2000). The overall economic impact of reflux disease appears to be significant. Cost of illness studies performed in the U.S. and Great Britain reported annual costs of several hundred Swiss francs per person (Levin et al. 1997;Eggleston et al. 1998). Information on the cost of illness of reflux disease in Switzerland has not been published so far. ObjectivesTo address the epidemiology and economics of reflux disease in Switzerland, with a principal focus on prevalence, on the utilisation of health care resources, and on associated costs. Methods Data collectionA population-based survey using computer-assisted telephone interviews (CATIs) was conducted in November 2000. Interviewees were selecte...

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Section: Choice Of Risk Scorementioning

confidence: 99%

Epidemiology and costs of gastroesophageal reflux disease in Switzerland: a population-based study

Schwenkglenks

Marbet²,

Szucs

2004

Sozial- und Pr�ventivmedizin/Social and Preventive Medicine

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“…Outro dado importante desta amostra foi o encontro de determinados sintomas associados ao refluxo laringofaringeano: disfonia (72,5%), pigarro (60,8%), tosse (29,4%), globus (23,5%) e sialorréia (19,6%). Além disso, cerca de 62,7% dos pacientes apresentavam mais de três sintomas associados, evidenciando a importância mais uma vez da anamnese na construção da suspeita clínica 1,8,10,12 . O adequado diagnóstico de refluxo gastro-esofágico com repercussões laríngeas necessita de tratamento especí-fico 8,19 .…”

Section: Discussionunclassified

“…Hoje sabe-se que há alterações detectadas ao exame histológico que não são revelados à endoscopia e à pHmetria de 24 horas 13 . Há autores que questionam a necessidade de exames sofisticados para a condução do refluxo gastro-esofágico e preferem o uso empírico de drogas como teste terapêutico e como ferramenta propedêutica 7,10,12 . A transposição destas terapêuticas para o refluxo laringofaríngeo ainda não estão sedimentadas, contudo, claro que ao não se dispor de meios adequados para uma completa investigação, pode-se optar por se iniciar o tratamento 19 .…”

Section: Discussionunclassified

“…A resposta ao tratamento clínico devidamente conduzido dará subsídios para a decisão da necessidade ou não de intervenção cirúrgica 25 . A opção pela cirurgia ganha cada vez mais simpatizantes, devido aos bons resultados relatados, à crescente refratariedade ao uso de medicamentos e à necessidade de terapia por tempo prolongado 12,25,26 . A endoscopia laríngea, associada quando possível à estroboscopia, geralmente é o primeiro exame solicitado pelo otorrinolaringologista.…”

Section: Introductionunclassified

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Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a pHmanometria de 24 horas de 2 canais

Marambaia

Andrade

Varela

et al. 2002

Rev. Bras. Otorrinolaringol.

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Introdução: Manifestações laríngeas do refluxo gastro-esofágico são problemas cada vez mais comuns. Estudos revelam alta associação com sensação de "globus", rouquidão crônica e com tosse crônica. Seu diagnóstico e tratamento diferem da clássica doença do refluxo gastro-esofágico. Os achados à endoscopia laríngea de hiperemia e edema de estruturas glóticas, espessamento do espaço interaritenóideo, granulomas, pólipos, edema de Reinke, estenose subglótica sugerem uma investigação diagnóstica completa através da pHmanometria de 24 horas, exame de maior sensibilidade e especificidade. Objetivos: correlacionar achados clínicos e laringoscópicos precoces sugestivos de refluxo gastro-esofágico com resultados da pHmanometria de 24 horas. Avaliar terapia medicamentosa e modificações dietéticas. Forma de estudo: clínico prospectivo randomizado. Método: 61 pacientes adultos com queixas crônicas: tosse seca, "globus", sialorréia, disfonia, pigarro, halitose e engasgos. Foram excluídos pacientes com outras patologias de vias aéreas. Endoscopia laríngea descartava aqueles que apresentassem lesões laríngeas mais avançadas. Encaminhamento à pHmanometria e iniciado tratamento clínico. Resultados: 83,6% apresentaram refluxo patológico. Sintomas mais freqüentes: disfonia (72,5%), pigarro (60,8%), tosse (29,4%), "globus" (23,5%) e sialorréia (19,6%). Associação de sintomas: dois (67,4%); três (41,2%) e quatro (21,5%). 49 pacientes iniciaram tratamento com omeprazol (20 mg) e dieta: 83,7% cursaram com melhora dos sintomas após 6 meses. Em 95,9% dos pacientes tratados houve melhora laringoscópica. Conclusões: Houve uma correlação importante entre história clínica e endoscopia laríngea com achados à pHmanometria de 24 horas. Outros estudos poderão fortalecer a telescopia laríngea para o diagnóstico do refluxo laringofaríngeo e seu acompanhamento. É necessária abordagem multidisciplinar, além de um aumento do grau de suspeição do especialista.

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“…Additionally, on-demand or as-needed use of PPIs is expanding and is consistent with the patient behavior that I have commonly observed in stable patients; it also can successfully and safely reduce PPI consumption. 10,11 The concluding point written by Wahlqvist dealt with the "unwarranted" focus of payers on the cost of medication. Citing his own research, published in abstract form only, he asserts that 17% of gastroesophageal reflux disease (GERD)-related costs are due to medications, while the other 83% are due to physician appointment costs, procedures, workers' compensation, short-and long-term disability, and decreased work productivity.…”

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confidence: 99%

PPIs Are Therapeutically Interchangeable and Ideal for a Managed Care Intervention Such as Therapeutic MAC

Crownover¹

2006

JMCP

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A Cost-Effectiveness Analysis of Prescribing Strategies in The Management of Gastroesophageal Reflux Disease

Abstract: For patients with moderate to severe symptoms of GERD, initial treatment with PPIs followed by on-demand therapy is a cost-effective approach.

Cited by 107 publications

References 67 publications

Epidemiology and costs of gastroesophageal reflux disease in Switzerland: a population-based study

Epidemiology and costs of gastroesophageal reflux disease in Switzerland: a population-based study

Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a pHmanometria de 24 horas de 2 canais

PPIs Are Therapeutically Interchangeable and Ideal for a Managed Care Intervention Such as Therapeutic MAC

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