We sought to evaluate the cost-effectiveness of diagnostic strategies to determine whether or not acid reflux exacerbates asthma, and to identify which asthma response probabilities are most important in a cost-effective workup of this problem.
We performed a cost-effectiveness analysis, comparing 11 diagnostic strategies to assess the role that acid reflux plays in asthma.
Probabilities and costs were derived from the published literature.
Average and incremental costs, effectiveness, and cost-effectiveness were calculated for each strategy.
Sensitivity analyses were performed.
The most cost-effective diagnostic approach is to begin with omeprazole 20 mg/day for 3 months, followed by 24-h pH testing on drug in nonresponders.
If 24-h pH testing is positive, increase the omeprazole dose every 3 months until the patient responds or a maximum of 60 mg/day is given.
This strategy costs $730 per case correctly diagnosed.
When the cost of pH testing exceeds $586 or the cost of omeprazole 20 mg/day is<$53 per month, omeprazole 20 mg/day for 3 months followed by 60 mg/day for the same duration in nonresponders becomes more cost-effective.
Empiric acid reflux suppression, followed by pH testing in nonresponders, is the most cost-effective means of determining whether GERD is aggravating a pa-tient's asthma.
Mots-clés Pascal : Reflux gastrooesophagien, Complication, Aggravation, Asthme, Diagnostic, Coût, Sensibilité, Analyse avantage coût, Homme, Appareil digestif pathologie, Oesophage pathologie, Appareil respiratoire pathologie, Bronchopneumopathie obstructive, Economie santé, Test therapeutique
Mots-clés Pascal anglais : Gastroesophageal reflux, Complication, Aggravation, Asthma, Diagnosis, Costs, Sensitivity, Cost benefit analysis, Human, Digestive diseases, Esophageal disease, Respiratory disease, Obstructive pulmonary disease, Health economy, Tgerapy-based diagnosis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0321987
Code Inist : 002B24J. Création : 16/11/1999.