Kosten-Effektivitäts- und Kosten-Nutzwert-Analysen der Antirefluxmedizin

Zusammenfassung

Einleitung Die laparaskopische Antirefluxplastik und die medikamentöse Therapie mit Säureblockern sind Goldstandard der Therapie der gastroösophagealen Refluxerkrankung. Aufgrund begrenzter Ressourcen bei gleichzeitig steigenden Gesundheitsbedürfnissen und -kosten sollen in der vorliegenden Arbeit beide Methoden nicht nur hinsichtlich des medizinisch besten Resultats, sondern auch in Bezug auf ihre gesundheitsökonomische Überlegenheit untersucht werden.

Methodik Es erfolgte eine elektronische Literaturanalyse in den Datenbanken MEDLINE, PubMed, Cochrane Library, ISRCTN (International Standard Randomization Controlled Trial Number) sowie in der NHS Economic Evaluation Database bis 01/2017. Eingeschlossen wurden nur Studien, welche als Zielparameter die Effektgrößen QALY (=Quality-Adjusted Life Years) (unter Berücksichtigung verschiedener Lebensqualitäts-Scores) im Vergleich von laparoskopischer Fundoplikatio und medikamentöser Therapie umfassten. Kriterien, anhand derer die Studien gegenübergestellt und verglichen wurden, waren die Effektgrößen QALY (Quality-Adjusted Life Years) bzw. daraus resultierend ICER (Incremental Cost-Effectiveness Ratio=inkrementelle Kosten-Effektivitäts-Relation)/ICUR (Incremental Cost-Utility Ratio=inkrementelle Kosten-Nutzen-Relation). Je inkludierter Publikation wurde anhand dieser Parameter die Superiorität des jeweiligen Verfahrens herausgearbeitet.

Resultate Es konnten insgesamt 18 vergleichende Studien in der aktuellen Literatur zu o. g. Suchbegriffen identifiziert werden, die die definierten Einschlußkriterien erfüllten. 6 Studien konnten final in unsere Analysen eingeschlossen werden. Es zeigt sich bei 3 der 6 analysierten Publikationen eine bessere Kosteneffektivität zugunsten der laparoskopischen Fundoplikatio. Limitationen sind aufgrund unterschiedlicher Zeithorizonte, Evidenzlevel der Studien und zugrundeliegender Ressourcen/Kosten der Analysen, verschiedener Gesundheitssysteme und angewandter Lebensqualitäts-Instrumente gegeben.

Schlussfolgerung Künftige prospektiv-randomisierte Studien müssen diesen Vergleich noch ausführlicher untersuchen. Zudem findet sich ein großes Potenzial für weitere Studien in der gesundheitsökonomischen Beurteilung von Früherkennungs- und Präventionsmaßnahmen der Refluxerkrankung bzw. des Barrett-Ösophagus und -Karzinoms.

Abstract

Introduction Laparoscopic antireflux surgery and medical therapy with proton pump inhibitors are gold standards of gastroesophageal reflux treatment. On account of limited resources and increasing healthcare needs and costs, in this analysis, not only optimal medical results, but also superiority in health economics of these 2 methods are evaluated.

Methods We performed an electronic literature survey in MEDLINE, PubMed, Cochrane Library, ISRCTN (International Standard Randomization Controlled Trial Number) as well as in the NHS Economic Evaluation Database, including studies published until 1/2017. Only studies considering the effect size of QALY (Quality-Adjusted Life Years) (with respect to different quality of life-scores) as primary outcome comparing laparoscopic fundoplication and medical therapy were included. Criteria of comparison were ICER (Incremental Cost-Effectiveness Ratio) and ICUR (Incremental Cost-Utility Ratio). Superiority of the respective treatment option for each publication was worked out.

Results In total, 18 comparative studies were identified in the current literature with respect to above-mentioned search terms, qualifying for the defined inclusion criteria. Six studies were finally selected for analyses. Out of 6 publications, 3 showed superiority of laparoscopic fundoplication over long-term medical management based on current cost-effectiveness data. Limitations were related to different time intervals, levels of evidence of studies and underlying resources/costs of analyses, healthcare systems and applied quality of life instruments.

Conclusion Future prospective, randomized trials should examine this comparison in greater detail. Additionally, there is a large potential for further research in the health economics assessment of early diagnosis and prevention measures of reflux disease and Barrett's esophagus/carcinoma.

Schlüsselwörter

Gastroösophageale Refluxerkrankung - Antirefluxmedizin - laparoskopische Fundoplikatio - medikamentöse Therapie - Protonenpumpeninhibitoren - inkrementelle Kosteneffektivitäts-/Kostennutzen-Relation (ICER/ICUR)

Key words

Gastroesophageal reflux disease - antireflux medicine - laparoscopic fundoplication - medical therapy - proton pump inhibitors - incremental costeffectiveness/cost-utility ratio (ICER/ICUR)

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