Comparaison des rapports cout-efficacite du traitement de l'oesophagite par reflux par omeprazole et ranitidine [Cost-effectiveness comparison between omeprazole and ranitidine for treatment of reflux oesophagitis]
Bergmann J F, Hamelin B, Barbier J P
Record Status
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology
Omeprazole versus ranitidine for the treatment of reflux oesophagitis.
Type of intervention
Treatment.
Economic study type
Cost-effectiveness analysis.
Study population
Patients with reflux oesophagitis of grade 2 or grade 3.
Setting
Primary care. The economic study was carried out in France.
Dates to which data relate
Costs were expressed in 1992 French francs. No other dates were given.
Source of effectiveness data
Single study.
Link between effectiveness and cost data
The resource data were collected alongside the clinical trial.
Study sample
Overall, 430 patients were included in the study. 136 and 294 were randomised to the ranitidine and omeprazole groups respectively. No power calculations were reported.
Study design
Randomised controlled trial, multicentre study. The follow-up was at 4 and 8 weeks. There was loss to follow-up, since overall 396 patients underwent the endoscopy: 123 in the ranitidine group and 273 in the omeprazole group.
Analysis of effectiveness
The analysis was based on intention to treat. The main outcome was the disappearance of the erosions at 8 weeks. The absence of pain reported by the patients was also considered as well as their life satisfaction index. The groups were comparable in terms of clinical and prognostic features.
Effectiveness results
The disappearance of the erosions after 8 weeks of treatment was found in 93% of the patients in the omeprazole group and in 67.5% in the ranitidine group. 80.9% of the patients in the omeprazole group reported an improvement in their health status, versus 53.2% in the ranitidine group.
Modelling
A logistic regression was carried out to determine the factors which positively contributed to the healing process of the oesophagitis.
Measure of benefits used in the economic analysis
The main outcome was the disappearance of the erosions at 8 weeks. The absence of pain reported by the patients was also considered as well as the life satisfaction index after 8 weeks.
Direct costs
The perspective of the payer was adopted in the cost analysis. Costs included the price of the drugs as currently advertised, medical care at 4 and 8 weeks (standard fees) and endoscopy (costs as recently evaluated in a study). Costs were based on actual data (unit of analysis). 1992 prices were used.
Currency
French francs.
Sensitivity analysis
A sensitivity analysis was carried out on the effectiveness data. The methods used were not specified.
Estimated benefits used in the economic analysis
The disappearance of the erosions after 8 weeks of treatment was found in 93% of the patients in the omeprazole group and in 67.5% in the ranitidine group. 80.9% of the patients in the omeprazole group reported an improvement in their health status, versus 53.2% in the ranitidine group.
Cost results
These were not reported separately. See the following field.
Synthesis of costs and benefits
Omeprazole was more cost-effective than ranitidine: cost per healed patient was 2,338 FF. vs 2,774 FF; cost per asymptomatic patient was 2,510 FF vs 2,964 FF; cost per patient with a goodor very good life satisfaction index was 2,687 FF vs 3,456 FF.
Authors' conclusions
The authors concluded that for the treatment of reflux oesophagitis, the strategy with the more effective treatment is more cost-effective.
CRD Commentary
This is a simple and good study. However the applicability to UK settings should be carefully assessed, in particular the cost side.
Bibliographic details
Bergmann J F, Hamelin B, Barbier J P. Comparaison des rapports cout-efficacite du traitement de l'oesophagite par reflux par omeprazole et ranitidine. [Cost-effectiveness comparison between omeprazole and ranitidine for treatment of reflux oesophagitis] Gastroenterologie Clinique et Biologique 1995; 19(5): 482-486