gms | German Medical Science

49. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
19. Jahrestagung der Schweizerischen Gesellschaft für Medizinische Informatik (SGMI)
Jahrestagung 2004 des Arbeitskreises Medizinische Informatik (ÖAKMI)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Schweizerische Gesellschaft für Medizinische Informatik (SGMI)

26. bis 30.09.2004, Innsbruck/Tirol

Management of gastroesophageal reflux disease in routine care: factors and costs related to poor treatment response

Meeting Abstract (gmds2004)

  • corresponding author presenting/speaker Michael Kulig - Charité University Medical Center, Berlin, Deutschland
  • Marc Nocon - Charité University Medical Center, Berlin, Deutschland
  • Andreas Leodolder - Otto-von-Guericke University, Magdeburg, Deutschland
  • Michael Vieth - Otto-von-Guericke University, Magdeburg, Deutschland
  • Daniel Jaspersen - Klinikum Fulda, Fulda, Deutschland
  • Joachim Labenz - Ev. Jung-Stilling-Krankenhaus, Siegen, Deutschland
  • Tore Lind - AstraZeneca R&D, Mölndal, Schweden
  • Wolfgang Meyer-Sabellek - AstraZeneca, Wedel, Deutschland
  • Manfred Stolte - Klinikum Bayreuth, Bayreuth, Deutschland
  • Peter Malfertheiner - Otto-von Guericke University, Magdeburg, Deutschland
  • Stefan N. Willich - Charité University Medical Center, Berlin, Deutschland

Kooperative Versorgung - Vernetzte Forschung - Ubiquitäre Information. 49. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 19. Jahrestagung der Schweizerischen Gesellschaft für Medizinische Informatik (SGMI) und Jahrestagung 2004 des Arbeitskreises Medizinische Informatik (ÖAKMI) der Österreichischen Computer Gesellschaft (OCG) und der Österreichischen Gesellschaft für Biomedizinische Technik (ÖGBMT). Innsbruck, 26.-30.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04gmds142

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gmds2004/04gmds142.shtml

Veröffentlicht: 14. September 2004

© 2004 Kulig et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Purpose

Gastroesophageal reflux disease (GERD) is a frequent condition with a prevalence of symptoms up to 50% in the general population. GERD is characterised by frequent relapses requiring long-term management. We aim to evaluate patients characteristics including quality of life (QoL) and disease-related costs during 2 years of routine care (RC) in relation to poor treatment response.

Methods

ProGERD is a multicentre cohort study of 6215 outpatients with GERD. Patients were endoscoped and received standardised treatment with a proton pump inhibitor (PPI) for 2 to 8 weeks. Treatment response was evaluated until week 8. Poor treatment response had occurred if reflux symptoms were not sufficiently resolved and/or if erosions of the esophagus had not healed (in patients with erosive disease [ERD]). During the following observational period, patients received RC at the discretion of their primary care physician. After 1 and 2 years of RC, patient and disease variables were assessed by patient questionnaires (response 90% and 86%), including a reflux symptom score (RDQ, min: 0, max: 36), and a disease specific QoL score (QOLRAD, min: 1, max: 7). Direct cost data (physician visits and hospital admissions during the previous 12 months and medication intake during the previous 3 months extrapolated for the previous 12 months) were calculated by multiplying disease related medical resource units with cost factors by unit. Indirect cost data (productivity loss) were calculated by multiplying days off work due to GERD during the previous 12 months with the average cost factor per day (societal perspective). Factors associated with initial poor treatment response (vs. adequate response) were analysed by multiple logistic regression analysis adjusted for age and education.

Results

Of all patients (mean age 54+-14, 47% female), the majority were excellent or sufficient treatment responders (STRs), while 31% were poor treatment responders (PTR) during the initial acute treatment phase (27% of the patients had not experienced sufficient symptom resolution and in 12% of 3245 ERD patients erosions had not completely healed). During the following 2 years of RC, the PTRs reported still significantly higher reflux symptom scores [OR: 1.05, 95% C.I. 1.04;1.06], lower QoL scores [OR: 0.91, 95% C.I. 0.84;0.98], and more often concomitant diseases [OR: 1.71, 95% C.I. 1.36;2.15] than the initial STRs. PTRs caused higher disease-related direct (472 vs. 315 EUR per patient per year) and indirect costs (83 vs. 35 EUR per patient per year) than the STRs during the 2 years of RC. In addition, PTRs who continued to report low QoL scores over the 2 years (lowest tercile of QOLRAD) had higher direct GERD-related costs (602 vs. 320 EUR per patient per year) than initial PTRs who reported high QoL later on during the follow-up (highest tercile of QOLRAD). Despite the high symptom load and low QoL among the PTRs, 25% of them did not take any reflux medication and 15% of them took other reflux medication than PPIs during the 2-year follow-up. Those patients were 4-times more likely [OR: 4.1, 95% C.I. 2.60;6.94] to experience frequent and severe symptoms and low QoL than regular PPI users.

Conclusion

During RC of patients with GERD, the still high symptom load and the high percentage of not adequate medication use among initially poor treatment responders suggest under-treatment in long-term management of GERD with significantly negative impact on QoL and disease-related costs (602 vs. 320 EUR per patient per year).

Acknowledgment

Sponsored by AstraZeneca