Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2002 Aug;236(2):191-202.
doi: 10.1097/00000658-200208000-00007.

Medical or Surgical Therapy for Erosive Reflux Esophagitis: Cost-Utility Analysis Using a Markov Model

Affiliations
Free PMC article
Case Reports

Medical or Surgical Therapy for Erosive Reflux Esophagitis: Cost-Utility Analysis Using a Markov Model

Joseph Romagnuolo et al. Ann Surg. .
Free PMC article

Abstract

Objective: To compare the cost and utility of healing and maintenance regimens of omeprazole and laparoscopic Nissen fundoplication (LNF) in the framework of the Canadian medical system.

Summary background data: Medical therapy with proton pump inhibitors for endoscopically proven reflux esophagitis is a safe and effective treatment option. Of late, the surgical treatment of choice for this disease has become LNF.

Methods: The authors' base case was a 45-year-old man with erosive reflux esophagitis refractory to H2-blockers. A cost-utility analysis was performed comparing the two strategies. A two-stage Markov model (healing and maintenance phases) was used to estimate costs and utilities with a time horizon of 5 years. Discounted direct costs were estimated from the perspective of a provincial health ministry, and discounted quality-of-life estimates were derived from the medical literature. Sensitivity analyses were performed to test the robustness of the model to the authors' assumptions and to determine thresholds. A Monte Carlo simulation of 10,000 patients was used to estimate variances and 95% interpercentile ranges.

Results: For the 5-year period studied, LNF was less expensive than omeprazole (3519.89 dollars vs. 5464.87 dollars per patient) and became the more cost-effective option at 3.3 years of follow-up. The authors found that 20 mg/day omeprazole would have to cost less than 38.60 dollars per month before medical therapy became cost effective; conversely, the cost of LNF would have to be more than 5,273.70 dollars or the length of stay more than 4.2 days for medical therapy to be cost effective. Estimates of quality-adjusted life-years did not differ significantly between the two treatment options, and the incremental cost for medical therapy was 129,665 dollars per quality-adjusted life-years gained.

Conclusions: For patients with severe esophagitis, LNF is a cost-effective alternative to long-term maintenance therapy with proton pump inhibitors.

Figures

None
Figure 1. Markov states and possible transitions modeled for the maintenance phases of the two treatment options: (A) omeprazole and (B) laparoscopic Nissen fundoplication.
None
Figure 2. A one-way sensitivity analysis comparing the two treatment options as they vary with the cost of omeprazole (medical therapy: dashed line; surgery: solid line). The threshold (point at which both therapies have equal expected costs) is $38.60/mo. The vertical dotted line represents the cost used in the model ($68.65).
None
Figure 3. A one-way sensitivity analysis comparing the two treatment options as they vary with the cost of surgery (medical therapy: dashed line; surgery: solid line). The threshold is $5,296.40. The vertical dotted line represents the cost used in the model ($3,091).
None
Figure 4. A one-way sensitivity analysis comparing costs of the two treatment options as they vary with time (medical therapy: dashed line; surgery: solid line). The threshold is 3.1 years or 12.2 cycles. At 5 years, surgery is the less expensive option.
None
Figure 5. This histogram displays the distribution of possible 5-year costs, using the Monte Carlo simulation of 10,000 hypothetical patients, of the two arms of the model.
None
Figure 6. A two-way sensitivity analysis, simultaneously examining the effects of omeprazole costs and anticipated duration of medical therapy on overall costs of the two strategies. The shaded area under the line highlights the coordinates that correspond to conditions where medical therapy would be the less expensive option. Coordinates falling above the line correspond to conditions for which surgery is the less expensive option.

Similar articles

See all similar articles

Cited by 11 articles

See all "Cited by" articles

Publication types

Feedback