内镜抗反流治疗比腹腔镜胃底折叠术更合算吗?  

Are endoscopic antireflux therapies cost-effective compared with laparoscopic fundoplication?

作　　者：Schiefke I Rogalski C Zabel-Langhennig A K.Caca 王志宇 

机构地区：[1]Department of Medicine II, University of Leipzig,Philipp-Rosenthal-Strafle 27, 04103 Leipzi g, Germany.Dr

出　　处：《世界核心医学期刊文摘（胃肠病学分册）》2005年第8期16-16,共1页Core Journals in Gastroenterology

摘　　要：Background and Study Aims: A number of endoscopic antireflux therapies (EATS) have emerged as potential nonmedical treatment options for patients with gastroe sophageal reflux disease(GERD). Concerns about clinical efficacy and costs have given rise to debate about their role in GERD management. The costs of laparosco pic fundoplication (LF) were compared with the costs of EAT when used in a seque ntial strategy that reserves the option of LF for EAT failure. Methods: A simple mathematical criterion of direct medical costs was applied. Published articles concerning EAT were reviewed to assess its effectiveness,durability and costs, i n order to estimate the parameters of the model. The costs of EAT and LF were ev aluated from the perspective of a German third-party payer. Only direct medical costs were considered. Results: Assuming that EAT has no impact on potential LF later on, the outcome of both strategies (LF, or EAT first with LF in case of f ailure of EAT) is identical and preference is a simple question of costs. The se quential strategy in nonmedical GERD treatment would be preferable if the long- term relief rate with EAT exceeds the ratio of the cost of EAT to the cost of LF . Long-term success rates of EAT do not exceed 0.65. At current prices EAT is c learly not cost-effective in Germany. Conclusion: Our simple criterion indicate s that EAT would only be cost-effective and beneficial in a sequential strategy if the costs of EAT were to be decreased to around 30%of current retail prices . However, long-term studies and randomized controlled trials are necessary to finally determine the role of EAT in GERD treatment, and the preference may chan ge in either direction.Background and Study Aims: A number of endoscopic antireflux therapies (EATS) have emerged as potential nonmedical treatment options for patients with gastroe sophageal reflux disease(GERD). Concerns about clinical efficacy and costs have given rise to debate about their role in GERD management. The costs of laparosco pic fundoplication (LF) were compared with the costs of EAT when used in a seque ntial strategy that reserves the option of LF for EAT failure. Methods: A simple mathematical criterion of direct medical costs was applied. Published articles concerning EAT were reviewed to assess its effectiveness,durability and costs, i n order to estimate the parameters of the model. The costs of EAT and LF were ev aluated from the perspective of a German third-party payer. Only direct medical costs were considered. Results: Assuming that EAT has no impact on potential LF later on, the outcome of both strategies (LF, or EAT first with LF in case of f ailure of EAT) is identical and preference is a simple question of costs. The se quential strategy in nonmedical GERD treatment would be preferable if the long- term relief rate with EAT exceeds the ratio of the cost of EAT to the cost of LF . Long-term success rates of EAT do not exceed 0.65. At current prices EAT is c learly not cost-effective in Germany. Conclusion: Our simple criterion indicate s that EAT would only be cost-effective and beneficial in a sequential strategy if the costs of EAT were to be decreased to around 30%of current retail prices . However, long-term studies and randomized controlled trials are necessary to finally determine the role of EAT in GERD treatment, and the preference may chan ge in either direction.

关 键 词：胃食管反流 医疗花费 药物治疗方法 随机对照试验 临床疗效 模型参数 持久性 第三方 

分 类 号：R655[医药卫生—外科学]