Abstract
Background
Gastroesophageal reflux disease (GERD) contributes to substantial medication use and costs worldwide. Economic evaluations provide insight into the value of healthcare, taking into account cost, quality, and benefits of particular treatments.
Objectives
Our objectives were to systematically review the existing literature to identify economic evaluations of GERD management strategies, to assess the scientific quality of these reports, and to summarize the economic outcomes of these evaluations.
Methods
We identified economic evaluations and cost studies of GERD management strategies by searching PubMed and the UK NHS Economic Evaluation Database via the Cochrane Library. Searching was restricted to articles in English-language journals from July 2003 to July 2013. Cost-identification articles were excluded from the final analysis.
Results
Eighteen articles were included in the final analysis; 61 % of these met all criteria for quality reporting. Overall, proton pump inhibitor (PPI) therapy was preferred (most effective and least costly) as empiric therapy for patients with reflux symptoms, except in patient populations with high Helicobacter pylori prevalence (>40 %). Initial empiric PPI therapy (vs. initial endoscopy stratification or H. pylori testing) is likely the most cost-effective initial strategy for patients with typical GERD symptoms. Surgery may be cost effective in patients with chronic GERD symptoms at time horizons of 3–10 years. Endoscopic anti-reflux procedures were not cost effective based on available data.
Conclusions
Further economic evaluations should adhere to standard reporting measures of cost estimates and outcomes, and should attempt to account for and compare the large heterogeneity of patient phenotypes and treatment effects seen with anti-reflux therapies.
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Acknowledgments
Financial support
Dr. Gawron was previously supported by a National Research Service Award postdoctoral fellow at the Institute for Healthcare studies under an institutional award from the Agency for Healthcare Research and Quality, T-32 HS 000078 (PI: Jane L. Holl, MD MPH). Dr. Pandolfino is supported by R01 DK079902 and R01 DK092217 from the Public Health Service.
Declaration of interests
Drs. Gawron and French have no outside interests to declare.
Dr. Pandolfino has served as a consultant for Given Imaging.
Dr. Howden has served as a consultant and speaker for Takeda, Otsuka, Ironwood and Forest, and as a speaker for GlaxoSmithKline International.
Author contributions
Andrew J. Gawron: guarantor of study, study design, design and modification of literature search, literature assessment and analysis, initial draft, and revision of manuscript.
Dustin D. French: design and modification of literature search, literature assessment and analysis, revision of manuscript.
John E. Pandolfino: study design, provided clinical content expertise and interpretation of results, revision of manuscript.
Colin W. Howden: study design, design and modification of literature search, revision of manuscript.
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Gawron, A.J., French, D.D., Pandolfino, J.E. et al. Economic Evaluations of Gastroesophageal Reflux Disease Medical Management. PharmacoEconomics 32, 745–758 (2014). https://doi.org/10.1007/s40273-014-0164-8
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DOI: https://doi.org/10.1007/s40273-014-0164-8