Cost effectiveness of medical versus surgical treatment in patients with severe or refractory gastroesophageal reflux disease in the Netherlands.
For a significant number of patients with severe or refractory gastroesophageal reflux disease, maintenance treatment with omeprazole and reflux surgery (Nissen fundoplication) are alternative treatment options.
In this study maintenance treatment with omeprazole is compared with open and laparoscopic Nissen fundoplication from a health-economic perspective.
Metaanalysis of published articles to assess effectiveness and simple decision-analytic techniques to combine costs and effects are used.
Findings and assumptions are submitted to sensitivity analysis.
It is estimated that it costs approximately 1880 Dutch guilders to initially heal a patient with severe or refractory esophagitis with 40 mg omeprazole daily.
When medical maintenance therapy was compared with surgery, it appeared that medical maintenance therapy with omeprazole (20-40 mg daily) for a prolonged period of time (more than 4 years) is less cost effective than a Nissen procedure.
It is estimated that a laparoscopic Nissen will shift this so-called break-even point towards 1.4 years, mainly due to a shorter hospital stay.
Although caution is required in drawing conclusions, it appears that replacing treatment with (laparoscopic) Nissen fundoplications in these patients might lead to substantial savings.
Mots-clés Pascal : Reflux gastrooesophagien, Réfractaire, Pays Bas, Europe, Oméprazole, Antisécrétoire, Inhibiteur enzyme, H+/K+-exchanging ATPase, Hydrolases, Enzyme, Intervention Nissen, Chimiothérapie, Etude comparative, Coût, Traitement, Homme, Economie santé, Appareil digestif pathologie, Oesophage pathologie, Chirurgie
Mots-clés Pascal anglais : Gastroesophageal reflux, Refractory, Netherlands, Europe, Antisecretory agent, Enzyme inhibitor, H+/K+-exchanging ATPase, Hydrolases, Enzyme, Nissen operation, Chemotherapy, Comparative study, Costs, Treatment, Human, Health economy, Digestive diseases, Esophageal disease, Surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0080356
Code Inist : 002B13A03. Création : 199608.