Choice of long-term strategy for the management of patients with severe esophagitis: a cost-utility analysis

Gastroenterology. 1997 Apr;112(4):1078-86. doi: 10.1016/s0016-5085(97)70118-5.


Background & aims: Omeprazole has shown remarkable efficacy and safety in the treatment of patients with gastroesophageal reflux disease (GERD); similarly, laparoscopic techniques have allowed less morbidity in patients undergoing fundoplication procedures. Concerns about the long-term cost and safety of both strategies have prompted a debate of their role in long-term management of patients with severe erosive esophagitis.

Methods: A cost-utility analysis was performed to compare two strategies: laparoscopic Nissen fundoplication (LNF) vs. omeprazole. A two-stage Markov model was used to obtain cost and efficacy estimates; all estimates were discounted at 3% per year. The time horizon was 5 years. Sensitivity analyses were performed on all relevant variables.

Results: Both strategies were similarly effective (4.33 quality-adjusted life years per patient), with omeprazole less expensive than LNF ($6053 vs. $9482 per patient). At 10 years, LNF and omeprazole costs were similar. Efficacy estimates were extremely sensitive to changes in quality of life associated with postoperative symptoms and long-term use of medication.

Conclusions: Medical therapy is the preferred treatment strategy for most patients with severe erosive esophagitis. Individuals with a long life expectancy are good candidates for LNF if postoperative morbidity is low and GERD symptoms remain abated for many years.

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Esophagitis / drug therapy*
  • Esophagitis / surgery*
  • Fundoplication*
  • Health Care Costs*
  • Humans
  • Markov Chains
  • Middle Aged
  • Monte Carlo Method
  • Omeprazole / therapeutic use*
  • Sensitivity and Specificity
  • Time Factors
  • Treatment Outcome


  • Omeprazole