Systematic review: patient‐centred endpoints in economic evaluations of gastro‐oesophageal reflux disease

Abstract

SUMMARYAim: To perform a systematic review of the economic literature on gastro-oesophageal reflux disease to evaluate (a) the use of patient-centred effectiveness endpoints, or (b) the use of patient-centred economic end-points, and the influence of these end-points on the outcome of the model. Methods: Three electronic databases (EMBASE, BIOSIS and Medline) were used, together with a manual search of meeting abstracts for relevant articles. The quality of the studies was determined by the Drummond criteria. Results: Our initial search identified 179 articles and a manual search revealed 78 abstracts and articles. A total of 47 studies (36 fully published articles and 11 abstracts) met the seven Drummond criteria for inclusion in our evaluation. Conclusions: This systematic review demonstrates that many of the published economic evaluations available today take the perspective of the third-party payer and focus on pharmaceutical costs relevant to the thirdparty payer. Our study also demonstrates that there are a number of costs of illness determinations, such that pharmaceutical costs account for only a small proportion of the total costs of managing gastro-oesophageal reflux disease. Future economic analyses should consider an evaluation of the patient's desire for complete symptom relief by including cost-utility assessments or willingness to pay data.

Long-term management of patients with symptoms of gastro-oesophageal reflux disease - a Norwegian randomised prospective study comparing the effects of esomeprazole and ranitidine treatment strategies on health-related quality of life in a general practit

“…Patients in this study did not undergo endoscopy prior to treatment, reflecting a trend towards increased use of empirical treatment of GERD without prior endoscopy (2,14). Caution is necessary, however, because a very small number of patients will have possible serious disease which is masked through the treatment of symptoms alone.…”

“…Thus, there is a trend towards increasing use of empirical treatment of GERD, without conducting prior endoscopy (2,14). The management pathways published in the Genval report show both early endoscopy and empirical therapy without endoscopy to be mainstream options for the treatment of patients with symptoms of reflux disease who do not have alarm symptoms (such as dysphagia, weight loss or haematemesis) (2).…”

Economic Reflections on Proton Pump Inhibitor Therapy for Non-Erosive Reflux Disease

“…This model, like all others in the literature, addressed cost-effectiveness from a third-party payer perspective. Future models should also evaluate treatment from a societal perspective [33] as reflux symptoms are associated with significant time off work [34] and even using conservative estimates societal costs can be higher than medical costs [35]. …”

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

“…Some data are published for England (49.4 million population), some England and Wales (52.3 million) and some for the UK (60 million). The adult population is estimated as 81.4% of the total population. A systematic review of published studies addressing the economics of GERD has been published recently 17 . It is not the purpose of this paper to revisit the whole literature but to draw out the key messages and themes relating to the economics of GERD using a narrative style.…”