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North of England Dyspepsia Guideline Development Group (UK). Dyspepsia: Managing Dyspepsia in Adults in Primary Care. Newcastle upon Tyne (UK): University of Newcastle upon Tyne; 2004 Aug 1. (NICE Clinical Guidelines, No. 17.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Dyspepsia: Managing Dyspepsia in Adults in Primary Care.

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Appendix 8Economic analyses addressing management of gastro-oesophageal reflux disease (GORD)

StudyMethodsOutcomesComparisonsResults
Stalhammar, 1993
Sweden
Markov
Deterministic
1 year
Discount NA
Societal costs (SEK 1991)
Healthy days
Erosive oesophagitisI1:I2:
I1:Intermittent: Omeprazole 20mg on relapseCost84688925
I2:Maintenance: Omeprazole 20mg from startEffect290353ICER: SEK16/health day
Both groups could step up to 40mg
Harris et al, 1997
USA
Markov
Deterministic
1 year
Discount NA
Direct costs (US$ 1995)
Recurrence
Erosive oesophagitisI1:I2:
I1:Maintenance dose PPICost12901157
I2:Maintenance 2X dose H2RAEffect0.1510.549ICER: $335/recurrence
I3:Maintenance with healing dose PPIHigh dose H2RA dominated.
Gerson et al, 2000
USA
Expected utility
Deterministic
1 year, but model extrapolates to lifetime costs and QALYs assuming steady state reached.
Discount: Not clear
Direct costs (US$)
QALYs
I1:antacidsI1:I2:I3:I4:I5:I6:
I2:Maintenance H2RACost ($)043299652784691376412616741112
I3:Step up H2RA – PPIEffect (QALYs)23.6624.4224.37242424.65
I4:Step down PPI –H2RAICER: $20934/QALY
I5:PPI on demandPPI on demand over antacids. All other comparisons dominated.
I6:Maintenance PPI
Ofman et al, 2002
USA
Expected utility
Deterministic
1 year.
Discount: NA
Direct costs (1997 US$)
% symptom free
I1:Step up [antacids, H2RA, PPI, investigate]I1:I2:
I2:Step down [PPI trial, H2RA, antacids]Cost$1045$1172
Effect50%75%ICER $510 in favour of step down
Briggs et al, 2002
Canadian
Expected Utility with Monte Carlo Simulation
Stochastic
1 year
Costs (2000 CAN$)I1:Intermittent Healing dose PPISee charts
I2:Continouous healing PPI
I3:Maintenance H2RA
I4:Prokinetic
I5:Step down PPI- H2RA
I6:Step down PPI- Maintenance PPI
Crown Copyright © 2004.
Bookshelf ID: NBK53756

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