Article Text
LETTERS TO THE EDITOR
Cost effectiveness of treatment for gastro-oesophageal reflux
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Editor,—Eggleston et al(Gut 1998;42:13–16) concluded from their observational study that the “step up” approach, starting with a prokinetic or H2 receptor antagonist, represents the most cost effective initial therapeutic strategy for the treatment of patients with a diagnosis of uncomplicated gastro-oesophageal reflux disease (GORD). In studies of the effects of treatments, non-randomised comparisons can be affected by confounding factors1 and in our opinion this has resulted in the wrong conclusions being drawn from this study. Therapeutic interventions are commonly prompted by an indication. Primary care physicians selectively treat patients exhibiting more severe GORD with omeprazole and less severe symptoms …