Economic Evaluations of Gastroesophageal Reflux Disease Medical Management

• Published in: PharmacoEconomics Vol. 32; no. 8; pp. 745 - 758
• Main Authors: Gawron, Andrew J., French, Dustin D., Pandolfino, John E., Howden, Colin W.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2014; Adis International; Springer; Springer Nature B.V
• Subjects: Biological and medical sciences; Clinical outcomes; Cost analysis; Cost benefit analysis; Cost estimates; Data Interpretation, Statistical; Diagnostic tests; Digestive system; Disease; Disease management; Dosage and administration; Drug therapy; Economy. Management; Endoscopy; Endoscopy, Gastrointestinal - economics; English language; Esophagus; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal reflux; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - economics; Gastroesophageal Reflux - surgery; Health Administration; Health and social institutions; Health Care Costs; Health care expenditures; Health care policy; Health Economics; Health maintenance organizations; Helicobacter infections; Helicobacter Infections - economics; Helicobacter Infections - microbiology; Helicobacter pylori - isolation & purification; HMOs; Humans; Laparoscopy; Libraries; Medical sciences; Medical treatment; Medicine; Medicine & Public Health; Methods; Other diseases. Semiology; Patients; Pharmacoeconomics and Health Outcomes; Pharmacology. Drug treatments; Prevention; Prices and rates; Proton pump inhibitors; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - economics; Proton Pump Inhibitors - therapeutic use; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life Research; Risk factors; Studies; Surgery; Systematic Review; United States; North America; America; United Kingdom > UK; Reflux Symptom; Economic Evaluation; Esomeprazole; Proton Pump Inhibitor; Gastroesophageal Reflux Disease; Human; Gastroesophageal reflux; Treatment; Health economy; Esophageal disease; Digestive diseases; Public health; Cost efficiency analysis; Proton pump inhibitor
• DOI: 10.1007/s40273-014-0164-8
• ISSN: 1170-7690; 1179-2027

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. Objectives Our objectives 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 UK 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 Helicobacter pylori prevalence (>40 %). Initial empiric PPI therapy (vs. initial endoscopy stratification or H.   pylori testing) is likely 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.