Riktig bruk av protonpumpehemmere ved reflukssykdom

Hatlebakk, Jan Gunnar; Emken, Birgitte-Elise Grinde; Glazkov, Valery; Hoff, Dag Arne Lihaug; Hausken, Trygve

doi:10.4045/tidsskr.12.0019

Cited by 2 publications

(2 citation statements)

References 22 publications

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“…Despite a lack of clinical guidance speci c to Norway, in line with the paradigms in the rest of Europe, medical management with PPI therapy is pursued [8]. Compared with other European countries, the use of PPIs in Norway is lower but has steadily increased at an approximate annual rate of 10% [11], likely increasing the overall cost of GERD treatment in the population.…”

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness of RefluxStop compared to proton pump inhibitors and Nissen fundoplication for management of persistent gastroesophageal reflux disease in Norway

Harper,

Kartha,

Mealing

et al. 2024

Preprint

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Background Heartburn, chest pain, and regurgitation are characteristics of gastroesophageal reflux disease. The standard treatment in Norway is proton pump inhibitors (PPIs), but surgical alternatives such as Nissen fundoplication are pursued when medical management proves ineffective. RefluxStop is an implantable device presenting a new approach to restoration of the antireflux barrier. The aim of this study is to evaluate the cost-effectiveness of RefluxStop, Nissen fundoplication, and PPI-based medical management (MM) in Norway.Methods A Markov model was adapted from a published cost-effectiveness analysis developed for the UK NHS assessing the cost-effectiveness of RefluxStop in comparison with PPI-based MM and Nissen fundoplication. The perspective of the Norwegian healthcare payer, lifetime horizon, one-month cycle length, and a 4% annual discount rate for costs and health-benefits were used. Health states included in the model were initial MM, MM relapse, follow-on surgery, reoperations, MM with a higher dose, Barrett’s esophagus, esophageal cancer, and death. Adverse events related to MM and surgeries were included with benefits measured in quality-adjusted life-years (QALYs). Norwegian diagnostic-related group tariffs and literature were used as sources for unit costs. Clinical efficacy data for RefluxStop was based on an ongoing clinical study and comparator treatments were informed by published studies. Deterministic and probabilistic sensitivity analyses were used to address uncertainty of the parameter estimates.Results Compared to PPI-based MM and Nissen fundoplication, the base case incremental cost-effectiveness ratios (ICERs) of RefluxStop were NOK 68,262 and NOK 79,543 per QALY gained, respectively. The results of the model were robust to variation in individual inputs with exception of monthly failure rate of RefluxStop relative to Nissen fundoplication. RefluxStop demonstrated a significantly high probability of cost-effectiveness at the cost-effectiveness threshold of NOK 275,000 per QALY gained, with probabilities of 100% and 92% against PPI-based MM and Nissen fundoplication, respectively.Conclusion The RefluxStop device is highly likely to be cost-effective compared to PPI-based MM and Nissen fundoplication in Norway. Further study is required to assess the real-world long-term safety and efficacy of this novel device.

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Section: Discussionmentioning

confidence: 99%

“…The usage of PPIs in Norway is lower in comparison to other European countries but has increased at a rate of 10% annually between 2003 and 2008 [11]. The reason for less frequent use in comparison to the rest of Europe may be attributable to the prescription rules in Norway.…”

Section: Introductionmentioning

confidence: 97%

Cost-effectiveness of RefluxStop compared to proton pump inhibitors and Nissen fundoplication for management of persistent gastroesophageal reflux disease in Norway

Harper,

Kartha,

Mealing

et al. 2024

Preprint

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Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction–Recommendations of the Nordic Working Group

Drewes

Munkholm

Simrén

et al. 2016

Scandinavian Journal of Pain

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AbstractBackground and aimsOpioid-induced bowel dysfunction (OIBD) is an increasing problem due to the common use of opioids for pain worldwide. It manifests with different symptoms, such as dry mouth, gastro-oesophageal reflux, vomiting, bloating, abdominal pain, anorexia, hard stools, constipation and incomplete evacuation. Opioid-induced constipation (OIC) is one of its many symptoms and probably the most prevalent. The current review describes the pathophysiology, clinical implications and treatment of OIBD.MethodsThe Nordic Working Group was formed to provide input for Scandinavian specialists in multiple, relevant areas. Seven main topics with associated statements were defined. The working plan provided a structured format for systematic reviews and included instructions on how to evaluate the level of evidence according to the GRADE guidelines. The quality of evidence supporting the different statements was rated as high, moderate or low. At a second meeting, the group discussed and voted on each section with recommendations (weak and strong) for the statements.ResultsThe literature review supported the fact that opioid receptors are expressed throughout the gastrointestinal tract. When blocked by exogenous opioids, there are changes in motility, secretion and absorption of fluids, and sphincter function that are reflected in clinical symptoms. The group supported a recent consensus statement for OIC, which takes into account the change in bowel habits for at least one week rather than focusing on the frequency of bowel movements. Many patients with pain receive opioid therapy and concomitant constipation is associated with increased morbidity and utilization of healthcare resources. Opioid treatment for acute postoperative pain will prolong the postoperative ileus and should also be considered in this context. There are no available tools to assess OIBD, but many rating scales have been developed to assess constipation, and a few specifically address OIC. A clinical treatment strategy for OIBD/OIC was proposed and presented in a flowchart. First-line treatment of OIC is conventional laxatives, lifestyle changes, tapering the opioid dosage and alternative analgesics. Whilst opioid rotation may also improve symptoms, these remain unalleviated in a substantial proportion of patients. Should conventional treatment fail, mechanism-based treatment with opioid antagonists should be considered, and they show advantages over laxatives. It should not be overlooked that many reasons for constipation other than OIBD exist, which should be taken into consideration in the individual patient.Conclusion and implicationsIt is the belief of this Nordic Working Group that increased awareness of adverse effects and OIBD, particularly OIC, will lead to better pain treatment in patients on opioid therapy. Subsequently, optimised therapy will improve quality of life and, from a socio-economic perspective, may also reduce costs associated with hospitalisation, sick leave and early retirement in these patients.

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Riktig bruk av protonpumpehemmere ved reflukssykdom

Cited by 2 publications

References 22 publications

Cost-effectiveness of RefluxStop compared to proton pump inhibitors and Nissen fundoplication for management of persistent gastroesophageal reflux disease in Norway

Cost-effectiveness of RefluxStop compared to proton pump inhibitors and Nissen fundoplication for management of persistent gastroesophageal reflux disease in Norway

Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction–Recommendations of the Nordic Working Group

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