Cost-effectiveness of different diagnostic strategies to assess gastro-oesophageal reflux disease in patients with unexplained chronic persistent cough in Italy

Baldi, Fabio; Cavoli, C.; Ghersi, Stefania; Mantovani, LG; Torresan, F.; Roda, Enrico

doi:10.1016/j.dld.2006.02.015

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…While non-cardiac chest pain may improve very rapidly with the use of PPIs, pulmonary or ENT symptoms may require long treatments at higher dosages before any effect appears [26, 27]. A clinical approach aimed at evaluating the best cost-effective diagnostic strategy for the treatment of gastroesophageal reflux associated with chronic persistent cough showed that the lowest cost is the strategy where PPI test is performed as first investigation [28]. In this context, recent studies indicate that a more effective suppression of intragastric acidity achieved with esomeprazole may result in a faster control of extraesophageal symptoms of GERD [29].…”

Section: Treating Gerd: Medical and Economical Considerations On A ‘Mmentioning

confidence: 99%

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

et al. 2007

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Proton pump inhibitors (PPIs) are antisecretory agents that are widely used in the short- and long-term management of gastroesophageal reflux disease (GERD) to relieve symptoms, heal esophagitis, and prevent complications, such as strictures and Barrett’s esophagus. The total healthcare costs of GERD are high, especially for maintenance treatment. Therefore, the choice of cost-effective therapeutic options is an ineluctable challenge for public health authorities, third-party payers, and patients. In some European Union countries, a recent trend of public health authorities is to promote the choice of less expensive PPIs, regardless of their antisecretory potency – this in spite of the evidence that newer PPIs provide superior symptom relief and esophageal erosion healing compared to earlier drugs. Several large clinical trials have demonstrated the superiority of esomeprazole over other PPIs at standard doses for both initial and continuous maintenance therapy in patients with moderate/severe erosive esophagitis. The non-erosive GERD poses a major challenge as this condition appears more frequently to be less responsive to PPIs. The use of PPIs with the strongest antisecretory properties might reveal to be more adequate and cost-effective, particularly for this indication.

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Section: Treating Gerd: Medical and Economical Considerations On A ‘Mmentioning

confidence: 99%

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

et al. 2007

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“…The majority of missing items were specific methods including mention of discount rates (n=4) [16,23–25] and study parameters (n=2) [16,25]. Three articles did not disclose funding sources [22–24] and four did not disclose conflicts of interest [17,20,22,23]. Of these, two included neither disclosure of funding nor conflicts of interest [22,23].…”

Section: Resultsmentioning

confidence: 99%

“…Of the eighteen included articles (Table 3), three used a decision analysis [18,22,24] nine used Markov modeling [9,10,12–14,17,20,21,23] and five our reported cost outcomes related to randomized trials [8,11,15,16,19]. Only one used a retrospective cohort design in assessing the incremental annualized healthcare costs of compliant and non-compliant PPI users [25].…”

Section: Resultsmentioning

confidence: 99%

“…Only one used a retrospective cohort design in assessing the incremental annualized healthcare costs of compliant and non-compliant PPI users [25]. Fifteen articles (78%) included comparisons of different PPI strategies (n=7, [16–21,23]) or PPI therapy with surgery (n=8, [8–15,24]). Four articles compared PPI therapy with endoscopic-based management (either as a diagnostic or therapeutic strategy) [9,16,17,22].…”

Section: Resultsmentioning

confidence: 99%

“…Four articles compared PPI therapy with endoscopic-based management (either as a diagnostic or therapeutic strategy) [9,16,17,22]. Of the twelve papers that used decision analysis or Markov models [9,10,12–14,17,18,20–24], nine were performed from a non-US societal or public health system perspective [9,12–14,17,20,21,23,24]. The majority of articles (n=15) used a public healthcare system perspective ( e.g .…”

Section: Resultsmentioning

confidence: 99%

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Economic Evaluations of Gastroesophageal Reflux Disease Medical Management

et al. 2014

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SUMMARY Background Gastroesophageal reflux disease (GERD) contributes to substantial medication use and costs worldwide. Economic evaluations provide insight into the value of healthcare, taking into account cost, quality, and benefits of particular treatments. Aims Our aims were to systematically review the existing literature to identify economic evaluations of GERD management strategies, to assess the scientific quality of these reports and to summarize the economic outcomes of these evaluations. Methods We identified economic evaluations and cost studies of GERD management strategies by searching PUBMED and the NHS economic evaluation database via the Cochrane library. Searching was restricted to articles in English language journals from July 2003 to July 2013. Cost identification articles were excluded from the final analysis. Results Eighteen articles were included in the final analysis; 61% of these met all criteria for quality reporting. Overall, proton pump inhibitor (PPI) therapy was preferred (most effective and least costly) as empiric therapy for patients with reflux symptoms, except in patient populations with high H. pylori prevalence (>40%). Initial empiric PPI therapy (vs. initial endoscopy stratification or H. pylori testing) is the most cost-effective initial strategy for patients with typical GERD symptoms. Surgery may be cost-effective in patients with chronic GERD symptoms at time horizons of 3–10 years. Endoscopic anti-reflux procedures were not cost-effective based on available data. Conclusions Further economic evaluations should adhere to standard reporting measures of cost estimates and outcomes, and should attempt to account for and compare the large heterogeneity of patient phenotypes and treatment effects seen with anti-reflux therapies.

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Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults

Chang¹,

Lasserson²,

Gaffney³

et al. 2006

Cochrane Database of Systematic Reviews

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There is insufficient evidence to definitely conclude that GORD treatment with PPI is universally beneficial for cough associated with GORD in adults. The beneficial effect was only seen in sub-analysis and its effect was small. The optimal duration of such a trial of therapy to evaluate response could not be ascertained in the meta-analysis although two RCTs reported significant change by 2 weeks of therapy. Clinicians should be cognisant of a period (natural resolution with time) and placebo effect in studies that utilise cough as an outcome measure. Data in children are inconclusive. Future paediatric and adult studies are needed whereby studies should be double blind, randomised controlled, parallel design, using treatments for at least two months, with validated subjective and objective cough outcomes and include ascertainment of time to respond as well as assessment of acid and/or non acid reflux whilst on therapy.

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Cost-effectiveness of different diagnostic strategies to assess gastro-oesophageal reflux disease in patients with unexplained chronic persistent cough in Italy

Cited by 9 publications

References 24 publications

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

Economic Evaluations of Gastroesophageal Reflux Disease Medical Management

Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults

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