Review article: gastro‐oesophageal reflux disease – the health economic implications

Abstract

SUMMARYFor the vast majority of patients with gastro-oesophageal reflux disease appropriate care involves the management of symptoms with lifestyle advice and drugs. However, there is dissension about the appropriate use of endoscopy, whether drugs should be stepped up or down according to potency, how long drugs should be used for, the role of lifestyle advice, and, related to this, the role of patients' lifestyle choices.This exploration of the economics of gastro-oesophageal reflux disease reviews its cost burden to the UK, assesses published economic models for their strengths and weaknesses and examines current recommendations for gastro-oesophageal reflux disease management from a socioeconomic perspective. Drugs prescribed predominantly for dyspepsia cost the UK National Health Service a projected £625 million in 2004, 7% of the primary care prescribing budget. When general practitioners consultations, endoscopies, over-the-counter sales and sickness absences are included the UK cost rises to £1.5 billion: approximately half of this cost can be ascribed to gastrooesophageal reflux disease. Emphasis upon regular review and stepping down treatment (while maintaining adequate symptom relief) is both clinically appropriate and resource efficient. Other cost-effectiveness issues largely lack objective answers because investment in treatment for gastro-oesophageal reflux disease depends upon how much more, at the margin, society wishes to invest for further but diminishing symptom relief.

Systematic review: frequency and reasons for consultation for gastro‐oesophageal reflux disease and dyspepsia

“…4,5 Gastrointestinal problems, including GERD, account for approximately 10% of consultations within the UK 6 and therapy costs were approximately £760 million in the UK in 2004. 7 However, studies suggest that only around a third of individuals with GERD consult a physician about their symptoms; the majority remain outside formal healthcare. 8 Individuals who consult a physician are likely to have different characteristics from those who do not consult, and may have a higher burden of illness and more complications arising from their disease.…”

Non-pharmacological intervention for gastro-oesophageal reflux disease in primary care

“…Costs are steady at an average of £220 million per year. 3,4 Research and expert opinion has informed effective prescribing patterns, 5 urged the need for regular review, 6 and challenged the longterm prescribing of PPIs. 7 Experimental studies have attempted to determine factors that exacerbate GORD symptoms, while population studies have explored socioeconomic and emotional issues that may influence symptom experience.…”

Helicobacter pylori eradication in long‐term proton pump inhibitor users is highly cost‐effective: economic analysis of the HELPUP trial

“…Managing dyspepsia is expensive: it has been estimated to cost over £1.0 billion in the UK per year. 10,11 Although the cost per prescription for PPI use has fallen dramatically in recent years, overall costs of PPI therapy in England have only recently begun to fall as drugs lose patent protection ( Figure 1). PPI use in primary care cost the NHS in England about £240 million in 2007, the lowest cost in a decade, although still a considerable demand on scarce resources.…”