>Economic and Clinical Outcomes Models for the Evaluation of Drug Therapy Strategies in Treatment of Gerd
Authors: McGhan W.1; Smith M.2; Crawley J.3
Source: Value in Health, Volume 1, Number 1, May 1998 , pp. 35-35(1)
Publisher: Blackwell Publishing
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Abstract:
Gastroesophageal reflux disease(GERD) usually requires long-term therapy. Treatment strategies include proton pump inhibitor (PPI) or H2receptor-antagonists (H2RA), or prokinetic agents.OBJECTIVE: A decision tree analytic model for comparing economic and clinical outcomes of GERD treatment strategies using continuous or intermittent therapy with PPI, H2RA, or prokinetic agents was developed. METHODS:Two decision tree models were constructed. One compared four continuous drug therapies; the other compared four intermittent drug treatments. Base values for heal rates and relapse frequencies were determied by analysis of published clinical data. Costs were drug, physician visit, endoscopy, and surgery costs. Clinical outcomes (percent of patients asymptomatic) and economic outcomes (direct costs) were determined at 12 months. RESULTS:The four continuous treatment strategies resulted in 99–100% asymptomatic patients at 1 year whereas the four intermittent strategies resulted in 76–80% asymptomatic patients at 1 year. At 1 year, the costs per asymptomatic patient, for continuous treatment strategies, were $1069, $1083, $1164, and $1193 for omeprazole 20 mg daily initially followed by omeprazole 10 mg, omeprazole 20 mg, or ranitidine 300 mg daily, or ranitidine 300 mg daily continously, respectively, and for intermittent strategy, were $1299, $1304, $1353, and $1455 for omeprazole 20 mg, cisapride 40 mg daily followed by omeprazole for failures, ranitidine 300 mg daily followed by omeprzole for failures, and ranitidine 300 mg daily followed by ranitidine 600 mg daily. Sensitivity analyses showed omeprazole cost and healing rate to have the greatest impact on the cost of treatment. CONCLUSIONS:These GERD decision tree analytic models are useful tools for comparing economic and clinical outcomes of drug treatment strategies over a wide range of costs and clinical efficacies.Document Type: Research article
DOI: 10.1046/j.1524-4733.1998.1100351.x
Affiliations: 1: Philadelphia College of Pharmacy and Science, Philadelphia, PA, USA 2: Health Decision Strategies, Princeton, NJ, USA 3: Astar Merck Inc., Wayne, PA, USA
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