Van Den Boom G, Go P M, Hameeteman W, Dallemagne B, Ament A J
Dept. of Health Economics, University of Limburg, Maastricht, Netherlands.
Scand J Gastroenterol. 1996 Jan;31(1):1-9. doi: 10.3109/00365529609031619.
For a significant number of patients with severe or refractory gastroesophageal reflux disease, maintenance treatment with omeprazole and reflux surgery (Nissen fundoplication) are alternative treatment options. In this study maintenance treatment with omeprazole is compared with open and laparoscopic Nissen fundoplication from a health-economic perspective.
Meta-analysis of published articles to assess effectiveness and simple decision-analytic techniques to combine costs and effects are used. Findings and assumptions are submitted to sensitivity analysis.
It is estimated that it costs approximately 1880 Dutch guilders to initially heal a patient with severe or refractory esophagitis with 40 mg omeprazole daily. When medical maintenance therapy was compared with surgery, it appeared that medical maintenance therapy with omeprazole (20-40 mg daily) for a prolonged period of time (more than 4 years) is less cost effective than a Nissen procedure. It is estimated that a laparoscopic Nissen will shift this so-called break-even point towards 1.4 years, mainly due to a shorter hospital stay.
Although caution is required in drawing conclusions, it appears that replacing treatment with (laparoscopic) Nissen fundoplications in these patients might lead to substantial savings.
对于相当数量的严重或难治性胃食管反流病患者，奥美拉唑维持治疗和反流手术（nissen胃底折叠术）是可供选择的治疗方案。在本研究中，从卫生经济学角度比较了奥美拉唑维持治疗与开放及腹腔镜nissen胃底折叠术。
采用对已发表文章的荟萃分析来评估有效性，并运用简单的决策分析技术来综合成本和效果。研究结果和假设进行敏感性分析。
估计用每日40毫克奥美拉唑初步治愈一名严重或难治性食管炎患者大约花费1880荷兰盾。当将药物维持治疗与手术进行比较时，发现长期（超过4年）使用奥美拉唑（每日20 - 40毫克）进行药物维持治疗的成本效益低于nissen手术。据估计，腹腔镜nissen手术将使这个所谓的收支平衡点变为1.4年，主要是因为住院时间较短。
尽管得出结论时需要谨慎，但在这些患者中用（腹腔镜）nissen胃底折叠术替代治疗似乎可能会节省大量费用。
