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胃食管反流病患者的诊断和治疗——成本效益和经济负担的系统评价。

Diagnosis and treatment of patients with gastroesophageal reflux disease - a systematic review of cost-effectiveness and economic burden.

机构信息

Betthera s.r.o, Hradec Kralove, Czech Republic.

Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic.

出版信息

BMC Health Serv Res. 2024 Nov 6;24(1):1351. doi: 10.1186/s12913-024-11781-8.


DOI:10.1186/s12913-024-11781-8
PMID:39501242
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11539747/
Abstract

BACKGROUND: This study aims to review the existing knowledge on the cost-effectiveness and item costs related to the diagnosis and treatment of gastroesophageal reflux disease (GERD) patients at different stages. METHODS: The study adhered to the PRISMA guidelines. The systematic search involved several steps: finding and identifying relevant articles, filtering them according to the set criteria, and examining the final number of selected articles to obtain the primary information. The number of articles published between 2013 and September 2024 in the Web of Science and PubMed databases was considered. The CHEERS checklist was used for the risk of bias assessment. Ultimately, 36 studies were included. RESULTS: Regarding the cost-effectiveness of GERD treatment, Proton pump inhibitors (PPIs) appeared to be the dominant solution for non-refractory patients. However, this might change with the adoption of the novel drug vonoprazan, which is more effective and cheaper. With advancements in emerging technologies, new diagnostic and screening approaches such as Endosheath, Cytosponge, and combined multichannel intraluminal impedance and pH monitoring catheters should be considered, with potential implications for optimal GERD management strategies. DISCUSSION: The new diagnostic methods are reliable, safe, and more comfortable than standard procedures. PPIs are commonly used as the first line of treatment for GERD. Surgery, such as magnetic sphincter augmentation or laparoscopic fundoplication, is only recommended for patients with treatment-resistant GERD or severe symptoms. OTHER: Advances in emerging technologies for diagnostics and screening may lead to a shift in the entire GERD treatment model, offering less invasive options and potentially improving patients' quality of life.

摘要

背景:本研究旨在综述不同阶段胃食管反流病(GERD)患者诊断和治疗的成本效益及项目成本的现有知识。

方法:研究遵循 PRISMA 指南。系统检索分以下几个步骤:寻找和识别相关文章,根据设定的标准进行筛选,检查最终选定文章的数量以获取主要信息。考虑了 2013 年至 2024 年 9 月间在 Web of Science 和 PubMed 数据库中发表的文章数量。使用 CHEERS 清单评估偏倚风险。最终纳入 36 项研究。

结果:关于 GERD 治疗的成本效益,质子泵抑制剂(PPIs)似乎是非难治性患者的主要解决方案。然而,随着新型药物 vonoprazan 的采用,这种情况可能会发生变化,因为它更有效且更便宜。随着新兴技术的进步,新的诊断和筛查方法,如 Endosheath、Cytosponge 和联合多通道腔内阻抗和 pH 监测导管,应该被考虑,这可能对 GERD 管理策略产生影响。

讨论:新的诊断方法可靠、安全且比标准程序更舒适。PPIs 通常被用作 GERD 的一线治疗药物。对于治疗抵抗性 GERD 或严重症状的患者,仅推荐手术,如磁括约肌增强术或腹腔镜胃底折叠术。

其他:诊断和筛查新兴技术的进步可能会导致整个 GERD 治疗模式的转变,提供更微创的选择,并有可能提高患者的生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cd3/11539747/dbc96d58ecd0/12913_2024_11781_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cd3/11539747/05fbb56ba2bd/12913_2024_11781_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cd3/11539747/4f580c7562fc/12913_2024_11781_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cd3/11539747/dbc96d58ecd0/12913_2024_11781_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cd3/11539747/05fbb56ba2bd/12913_2024_11781_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cd3/11539747/4f580c7562fc/12913_2024_11781_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cd3/11539747/dbc96d58ecd0/12913_2024_11781_Fig3_HTML.jpg

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引用本文的文献

[1]
Assessment of Burden of Partial Response to Standard Doses of Proton Pump Inhibitors in Patients with Clinically Diagnosed Gastroesophageal Reflux Disease: A Real-World Evidence Study in India.

Drugs Real World Outcomes. 2025-6-19

[2]
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[3]
Economic evaluation of proton pump inhibitors in patients with gastro-oesophageal reflux disease: a systematic review.

BMJ Open Gastroenterol. 2024-12-20

本文引用的文献

[1]
Cost-effectiveness of the RefluxStop device for management of refractory gastroesophageal reflux disease in Switzerland.

J Med Econ. 2024

[2]
Budget Impact of RefluxStop™ as a Treatment for Patients with Refractory Gastro-oesophageal Reflux Disease in the United Kingdom.

J Health Econ Outcomes Res. 2024-1-11

[3]
Current management of gastro-oesophageal reflux disease-treatment costs, safety profile, and effectiveness: a narrative review.

Gastroenterol Rep (Oxf). 2023-4-18

[4]
Global, regional, and national burden of 10 digestive diseases in 204 countries and territories from 1990 to 2019.

Front Public Health. 2023

[5]
Cost-effectiveness of a novel, non-active implantable device as a treatment for refractory gastro-esophageal reflux disease.

J Med Econ. 2023

[6]
Transoral incisionless fundoplication is cost-effective for treatment of gastroesophageal reflux disease.

Endosc Int Open. 2022-7-15

[7]
Global, regional and national burden of gastroesophageal reflux disease, 1990-2019: update from the GBD 2019 study.

Ann Med. 2022-12

[8]
ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease.

Am J Gastroenterol. 2022-1-1

[9]
Treatment strategies for reflux esophagitis including a potassium-competitive acid blocker: A cost-effectiveness analysis in Japan.

J Gen Fam Med. 2021-2-21

[10]
Prevalence and Financial Burden of Digestive Diseases in a Commercially Insured Population.

Clin Gastroenterol Hepatol. 2022-7

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