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On-Demand and Intermittent Therapy for Gastro-Oesophageal Reflux Disease

Economic Considerations

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Abstract

Since gastro-oesophageal reflux disease (GORD) is a prevalent condition characterised by frequent relapses, long-term costs of management for this disease are high. Thus, strategies to decrease resource expenditures without impairing patient quality of life are desirable. On-demand therapy (one-dose when symptoms occur) and intermittent therapy (short course of medication when symptoms occur) are attractive since pharmaceutical expenditures may be decreased, and many patients self-employ this strategy.

The purpose of this paper was to examine the economic implications of on-demand or intermittent therapy for GORD. A review of selected studies evaluating medication suitable for on-demand or intermittent administration was performed. A complete search for published studies on the cost effectiveness of on-demand or intermittent therapy for GORD was conducted, and the results discussed in detail.

Antacids, alginates, topically active agents, histamine2-receptor antagonists, and proton pump inhibitors have all demonstrable efficacy compared with placebo when administered on-demand. Proton pump inhibitors constitute the most effective pharmacological means to treat GORD. Although step-up strategies initially using less potent medication may decrease resource use, cost-effectiveness analysis illustrates that on-demand or intermittent therapy with proton pump inhibitors may be reasonable options. Further work that defines quality of life and patient preferences associated with GORD may allow for proper allocation of resources for the management of this condition.

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Notes

  1. Use of brand names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

Grant Support: Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service IIR 99-238-2 and American College of Gastroenterology Faculty Development Award.

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Authors and Affiliations

  1. VA Center for Practice Management and Outcomes Research and the University of Michigan Medical Center, 2215 Fuller Road, Ann Arbor, Michigan, 48105, USA

    John M. Inadomi

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  1. John M. Inadomi
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Correspondence to John M. Inadomi.

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Inadomi, J.M. On-Demand and Intermittent Therapy for Gastro-Oesophageal Reflux Disease. Pharmacoeconomics 20, 565–576 (2002). https://doi.org/10.2165/00019053-200220090-00001

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