OBJECTIVE: To determine the best treatment strategy for the management of p
atients presenting with symptoms consistent with uncomplicated heartburn.
METHODS: We performed a cost-utility analysis of 4 alternatives: empirical
proton pump inhibitor, empirical histamine,receptor antagonist, and diagnos
tic strategies consisting of either esophagogastroduodenoscopy (EGD) or an
upper gastrointestinal series before treatment. The time horizon of the mod
el 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 projecte
d to provide the greatest quality-adjusted survival for the cohort. Empiric
al treatment with a histamine, receptor antagonist was projected to be the
least costly of the alternatives. The marginal cost-effectiveness of using
a proton pump inhibitor over a histamine(2)-receptor antagonist was approxi
mately $10,400 per quality-adjusted life year (QALY) gained in the base cas
e analysis and was less than $50,000 per QALY as long as the utility for he
artburn was less than 0.95. Both diagnostic strategies were dominated by pr
oton 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 histamine,receptor antagonist depends on the impact of heartb
urn on quality of life.