The Cost of Postsurgical Syndromes (Based on the Example of Duodenal Ulcer Treatment)

Costs of medical and surgical treatment of duodenal ulcer

Proximal gastric vagotomy and intermittent and maintenance therapy with H2-antagonists have all been claimed to be effective in long-term management of duodenal ulcer disease. The model of a Markov chain was used to compare their costs by a medical decision analysis. The high price of the initial procedure made proximal gastric vagotomy the most expensive therapy, its costs rising from +10,600 after 1 yr to +12,200 after 15 yr. The average costs of intermittent therapy per patient rose from +500 to +7500. Maintenance therapy cost as much as intermittent therapy but provided 8% and 4% more time spent free of ulcer relapse and pain, respectively. In a sensitivity analysis, the order of the therapeutic options regarding their cost-effectiveness remained robust to changes in the assumptions underlying the model. In a European health care system, the initial surgical procedure cost only one-seventh of the average annual income compared with two-thirds in the United States, and proximal gastric vagotomy turned out to be the cheapest therapy after 6 yr. These results suggest that maintenance therapy provides the best long-term management. Gastric surgery may represent a cost-effective measure of ulcer prevention in Europe but not in the United States.

Economic assessment of peptic ulcer disease treatments

The cost and economic outcomes of peptic ulcer disease (PUD) treatments are important but uncommonly assessed by clinical researchers in gastroenterology. There is a growing interest in these assessments because of their implications for patient management and health care planning. Also, cost assessments offer the clinical researcher a powerful method to analyze the socioeconomic impact of different therapies in randomized prospective studies. The purposes of this paper are 1) to present methods and results of cost and economic assessment of PUD and 2) to consider the impact of H2 receptor antagonists on PUD cost. As with any chronic disease, PUD has direct and indirect costs. Direct costs are for hospital and clinic care, physicians' and surgeons' services, pharmacy fees, and nursing home care. Indirect costs of PUD affect society and include costs of absenteeism from work, disability, and mortality. Direct and indirect costs can be estimated prospectively in short-term and maintenance PUD clinical research studies. Several cost and economic analyses of PUD have been reported by clinical investigators and medical economists of different countries. They report a significant change in the direct and indirect costs of peptic ulcer treatment after the introduction of the H2 receptor antagonists.

The effect of highly selective vagotomy on sick-listing in peptic ulcer patients

The amount of sick-listing in 75 patients operated on with highly selective vagotomy (HSV) was studied during two periods, the first consisting of 12 months and ending 1 year before operation and the second period, also consisting of 12 months, starting 1 year after operation. Patients with suspected ulcer recurrences were excluded and only patients who, at the 1-year postoperative follow-up study, were without symptoms suggestive of ulcer recurrence are included. The median amount of sick days was 31.3 for the period preceding and 37.2 (NS) after the operation. Before operation 60% of all sick-leave diagnoses were ulcer or gastritis, compared with 20% after operation. A 50% increase in infectious diseases and lumbago occurred. Psychiatric disorders rose from 1 to 16 occasions. We therefore conclude that patients apparently cured of chronic ulcer disease change target and develop symptoms elsewhere. The study shows no potential economic benefits of HSV, at least not with regard to a diminishing amount of sick days after operation.