title: Low-dose or standard-dose proton pump inhibitors for maintenance therapy of gastro-oesophageal reflux disease: a cost-effectiveness analysis.
abstract: BACKGROUND
  Studies on the use of low-dose proton pump inhibitor for the maintenance therapy of gastro-oesophageal reflux disease have shown that it might be comparable with standard-dose proton pump inhibitor treatment and superior to standard-dose histamine-2 receptor antagonist therapy.
  
  
  OBJECTIVE
  To compare the impact of standard-dose histamine-2 receptor antagonist, low-dose proton pump inhibitor and standard-dose proton pump inhibitor treatment for the maintenance therapy of gastro-oesophageal reflux disease on symptom control and health care resource utilization from the perspective of a public health organization in Hong Kong.
  
  
  METHODS
  A Markov model was designed to simulate, over 12 months, the economic and clinical outcomes of gastro-oesophageal reflux disease patients treated with standard-dose histamine-2 receptor antagonist, low-dose proton pump inhibitor and standard-dose proton pump inhibitor. The transition probabilities were derived from the literature. Resource utilization was retrieved from a group of gastro-oesophageal reflux disease patients in Hong Kong. Sensitivity analysis was conducted to examine the robustness of the model.
  
  
  RESULTS
  The standard-dose proton pump inhibitor strategy was associated with the highest numbers of symptom-free patient-years (0.954 years) and quality-adjusted life-years gained (0.999 years), followed by low-dose proton pump inhibitor and standard-dose histamine-2 receptor antagonist. The direct medical cost per patient in the standard-dose proton pump inhibitor group (904 US dollars) was lower than those of the low-dose proton pump inhibitor and standard-dose histamine-2 receptor antagonist groups.
  
  
  CONCLUSIONS
  The standard-dose proton pump inhibitor strategy appears to be the most effective and least costly for the maintenance management of patients with gastro-oesophageal reflux disease in Hong Kong.
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China. joyceyou@cuhk.edu.hk
authors.forename: J H S
authors.initials: JH
authors.lastname: You
authors.forename: A C M
authors.initials: AC
authors.lastname: Lee
authors.forename: S C Y
authors.initials: SC
authors.lastname: Wong
authors.forename: F K L
authors.initials: FK
authors.lastname: Chan
mesh_terms: D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000191:economics; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000191:economics; D019057:Quality-Adjusted Life Years
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D017494:Proton Pumps