Original Contribution
The American Journal of Gastroenterology (2005) 100, 524–533; doi:10.1111/j.1572-0241.2005.40588.x
Patient-Derived Health State Utilities for Gastroesophageal Reflux Disease
Lauren B Gerson MD, MSc1, Nighat Ullah MD1, Trevor Hastie PhD1, George Triadafilopoulos MD1 and Mary Goldstein MD, MS1
1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California; Department of Statistics, Stanford University, Stanford, California; VA Palo Alto Health Care System, Palo Alto, California; Geriatrics Research Education and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, California; and Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, California
Correspondence: Lauren B. Gerson, MD, MSc, Division of Gastroenterology & Hepatology, Room A149, Stanford University Medical Center, Stanford, CA 94305-5202
Received 8 April 2004; Revised 0000; Accepted 3 August 2004.
Abstract
BACKGROUND AND AIMS:
Gastroesophageal reflux disease is a chronic disease that adversely affects health-related quality of life. The purpose of this study was to derive health state utilities for patients with chronic heartburn symptoms.
METHODS:
We used a custom-designed computer program in order to elicit utilities with the time-tradeoff and standard-gamble techniques. Patients with chronic (more than 6 months) symptoms of gastroesophageal reflux disease entered the study. Two interviews were performed in random sequence either initially on medications for heartburn that adequately controlled symptoms, or off of medications for 1 wk while the patient was symptomatic. We also collected data using visual-analog scales, quality of life in reflux and dyspepsia (QOLRAD), and Gastrointestinal Symptom Rating Scale (GSRS) scores.
RESULTS:
We invited 222 patients to participate; 158 (71%) patients (129 men, 29 women) completed the study. Barrett's esophagus was present in 40 (25%), erosive disease in 17 (11%), and 118 (74%) had comorbid conditions. The mean (
SD) utility ratings were 0.94 0.09 on medical therapy and 0.90 0.12 off medications for patients with reflux alone using time tradeoff (p= 0.004), and 0.94 8.0 both on and off of antireflux medications with standard-gamble assessment (p= 0.96). Mean time-tradeoff scores were also significantly lower off of medications for patients with other comorbid conditions (p= 0.002). There was no significant difference between mean utility scores for patients with or without Barrett's esophagus or erosive disease.
CONCLUSION:
Gastroesophageal reflux disease adversely affects health-related quality of life. Time-tradeoff utility for patients with reflux disease is substantially higher when patients are on medication than off medications.
