Valutazione economica del lansoprazolo nel trattamento dei pazienti affetti da reflusso esofageo

Summary

Objective To investigate the cost effectiveness ratio of different patterns of GORD management in Italy.

Design Cost effectiveness analysis based on a semi-markov model approach, and expressed as cost per relapse-free-patient and cost per avoided relapse. Costs were derived from Italian NHS tariffs, which is the perspective of analysis, while effectiveness was assessed through the literature.

Setting Italian inpatient and outpatient clinics.

Patients and participants An expert panel of 5 gastroenterologists, assessing patients with GORD Savary-Miller stages II, III, IV after the first acute episode of oesophagitis.

Interventions 1) No pharmacological maintainance, 2) lansoprazole 15 mg once daily, 3) lansoprazole 30 mg once daily.

Main outcome measures and results The total cost of care was 1.43, 1.22 and 1.79 billions Lire in the cohort of 1) no pharmacological maintainance, 2) lansoprazole 15 mg once daily, 3) lansoprazole 30 mg once daily respectively. No pharmacological maintainance alternative is dominated by lansoprazole 15 mg, which is both more effective and less expensive and is therefore the reference therapy. Incremental cost per relapse-free-patient and per avoided relapse of 30 mg vs 15 mg are 5.5 and 12.6 millions Lire.

Conclusion No pharmacological maintainance is inefficient. Lansoprazole 30 mg alternative is both more costly and effective compared to lansoprazole 15 mg. Lansoprazole 15 mg is, in our study, the reference therapy.