What Is Heartburn Worth?

doi:10.1046/j.1525-1497.2000.02639.x

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Wiley InterScience

Journal of General Internal Medicine

Volume 15 Issue 3, Pages 175 - 182

Published Online: 25 Dec 2001

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What Is Heartburn Worth?

A Cost-Utility Analysis of Management Strategies

Gustavo R. Heudebert, MD, Robert M. Centor, MD, Joshua C. Klapow, PhD, Robert Marks, MD, Lawrence Johnson, MD, C. Mel Wilcox, MD

Divisions of General Internal Medicine, University of Alabama at Birmingham, Birmingham, Ala. Gastroenterology, University of Alabama at Birmingham, Birmingham, Ala. Department of Medicine, and Birmingham VA Medical Center, University of Alabama at Birmingham, Birmingham, Ala. Department of Psychology, University of Alabama at Birmingham, Birmingham, Ala. School of Public Health, University of Alabama at Birmingham, Birmingham, Ala.

Address correspondence and reprint requests to Dr. Heudebert: T he University of Alabama at Birmingham, 621 Medical Education Bldg., 1813 Sixth Ave., Birmingham, AL 35294-3296 (E-mail: gheudebert@gim.meb.uab.edu).

KEYWORDS

cost-utility analysis • heartburn • proton pump inhibitor • histamine₂-receptor antagonist • quality of life

ABSTRACT

OBJECTIVE: To determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn.

METHODS: We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine₂-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice.

MAIN RESULTS: Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine₂ receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine₂-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative.

CONCLUSIONS: Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine₂-receptor antagonist depends on the impact of heartburn on quality of life.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1046/j.1525-1497.2000.02639.x About DOI