Medical or surgical therapy for erosive XXXX : cost-utility analysis using a Markov model.

@entity1 @entity2910 @entity11035 @entity354 @entity4546
OBJECTIVE: To compare the cost and utility of healing and maintenance regimens of @entity4546 and @entity11035 ( @entity11035 ) in the framework of the Canadian medical system. SUMMARY BACKGROUND DATA: Medical therapy with proton pump inhibitors for endoscopically proven @entity354 is a safe and effective treatment option. Of late, the surgical treatment of choice for this disease has become @entity11035 . METHODS: The authors' base case was a 45-year-old @entity1 with erosive @entity354 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 @entity1 was used to estimate variances and 95% interpercentile ranges. RESULTS: For the 5-year period studied, @entity11035 was less expensive than @entity4546 (3519.89 dollars vs. 5464.87 dollars per @entity1 ) and became the more cost-effective option at 3.3 years of follow-up. The authors found that 20 mg/day @entity4546 would have to cost less than 38.60 dollars per month before medical therapy became cost effective; conversely, the cost of @entity11035 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 @entity1 with severe @entity2910 , @entity11035 is a cost-effective alternative to long-term maintenance therapy with proton pump inhibitors.
