@article {Heudebert:March 2000:0884-8734:175,
	author = "Heudebert, Gustavo R.",
	author = "Centor, Robert M.",
	author = "Klapow, Joshua C.",
	author = "Marks, Robert",
	author = "Johnson, Lawrence",
	author = "Wilcox, C. Mel",
	title = "What Is Heartburn Worth?: A Cost-Utility Analysis of Management Strategies",
	journal = "Journal of General Internal Medicine",
	volume = "15",
	year = "March 2000",
	abstract = "OBJECTIVE: <P></P><I>T</I>o determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn<I>.</I> METHODS: <P></P>We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine<SUB>2</SUB>-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice. MAIN RESULTS: <P></P>Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine<SUB>2</SUB> receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine<SUB>2</SUB>-receptor antagonist was approximately &#36;10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than &#36;50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative. CONCLUSIONS: <P></P>Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine<SUB>2</SUB>-receptor antagonist depends on the impact of heartburn on quality of life.",
	pages = "175-182(8)",
	url = "http://www.ingentaconnect.com/content/bsc/jgi/2000/00000015/00000003/art00005"
	doi = "doi:10.1046/j.1525-1497.2000.02639.x"
}