Economic analysis of on-demand maintenance therapy with proton pump inhibitors in patients with non-erosive reflux disease.
OBJECTIVE
To evaluate the costs and effectiveness of on-demand maintenance therapy with oral esomeprazole, lansoprazole, omeprazole, pantoprazole or rabeprazole in patients with endoscopy-confirmed non-erosive reflux disease (NERD) in the UK.


METHODS
A probabilistic model was developed to compare the costs and effectiveness of five proton pump inhibitors (PPIs) in endoscopy-negative, symptomatic NERD patients who had complete resolution of heartburn symptoms following 4 weeks of open-label acute PPI treatment. The total annual expected costs (euro, 2003 values) and utilities gained per patient were measured over a 1-year horizon from the perspective of the UK NHS. Model uncertainty was addressed by sensitivity analyses.


RESULTS
The base-case annual median costs and utilities gained with on-demand PPI therapy were: 123 euro and 0.89 for rabeprazole 10mg; 176 euro and 0.90 for pantoprazole 20mg; 190 euro and 0.89 for esomeprazole 20mg; 195 euro and 0.91 for lansoprazole 15mg; 201 euro and 0.90 for omeprazole 20mg; and 210 euro and 0.91 for omeprazole 10mg. Differences in costs, but not in outcomes, were statistically significant. The results were robust to sensitivity analyses.


CONCLUSIONS
In this analysis, on-demand use of rabeprazole for the management of NERD incurred the least cost in comparison with the other PPIs evaluated. Utility gains were comparable for all on-demand PPIs. The place of on-demand PPIs in therapy, however, requires further evaluation.
Hughes
Dyfrig A
DA
Centre for the Economics of Health, IMSCaR, University of Wales, Bangor, UK. d.a.hughes@bangor.ac.uk
Bodger
Keith
K
Bytzer
Peter
P
de Herdt
Dirk
D
Dubois
Dominique
D
D000897:Anti-Ulcer Agents / Q000191:economics* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000191:economics; D006356:Heartburn / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors