title: Cost-effectiveness of proton-pump inhibitors for maintenance therapy of erosive reflux esophagitis.
abstract: The relative cost-effectiveness of proton-pump inhibitors (PPIs) in the maintenance therapy of erosive reflux esophagitis was studied. Decision analysis was used to model the cost-effectiveness of PPIs on the basis of clinical trial results. Management decisions in the model were based on published U.S. guidelines and recommendations. Probability estimates were derived from a systematic review of the literature. The model's base-case scenario compared rabeprazole, lansoprazole, and omeprazole for the prevention of symptom recurrence over one year. Meta-analyzed estimates of efficacy were derived from trials by using a generalized logistic regression model with random effects. Medical costs for hospitalization, procedures, and office visits reflected 2000 Medicare payment; drug costs were based on 2000 average wholesale prices. Average costs per patient were comparable among the PPIs (rabeprazole, $1414; lansoprazole, $1671; and omeprazole, $1599). Rabeprazole prevented symptom recurrence in 86% of rabeprazole recipients, versus 68% for lansoprazole and 81% for omeprazole, and yielded the lowest average cost-effectiveness ratio (rabeprazole, $1637 per recurrence prevented; lansoprazole, $2439; and omeprazole, $1968). The model was robust to changes in key variables. When evaluated by decision analysis over a wide range of assumptions, rabeprazole was comparable to other PPIs in terms of cost and offered improved effectiveness for maintenance therapy of erosive reflux esophagitis.
authors.affiliation: Zynx Health Inc., a Subsidiary of Cedars-Sinai Health System, Los Angeles, CA, USA. dean@zynx.com
authors.forename: B B
authors.initials: BB
authors.lastname: Dean
authors.forename: R M
authors.initials: RM
authors.lastname: Siddique
authors.forename: B D
authors.initials: BD
authors.lastname: Yamashita
authors.forename: A S
authors.initials: AS
authors.lastname: Bhattacharjya
authors.forename: J J
authors.initials: JJ
authors.lastname: Ofman
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001562:Benzimidazoles / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D004791:Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use; D004942:Esophagitis, Peptic / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D064747:Lansoprazole; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D064750:Rabeprazole
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001562:Benzimidazoles; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D064750:Rabeprazole; D009853:Omeprazole