title: "Proton-pump inhibitor-first" strategy versus "step-up" strategy for the acute treatment of reflux esophagitis: a cost-effectiveness analysis in Japan.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) is a common condition, and acid-suppressing agents are the mainstays of treatment. For the acute medical management of GERD, two different strategies can be proposed: either the most effective therapy, i.e., proton-pump inhibitors (PPIs), can be given first, or histamine H2-receptor antagonists (H2RAs) can be attempted first (the "step-up" approach).
  
  
  METHODS
  A clinical decision analysis comparing the PPI-first strategy and the H2RA-first "step-up" strategy for the acute treatment of reflux esophagitis in Japan was performed, using a Markov chain approach.
  
  
  RESULTS
  The PPI-first strategy was consistently superior to the step-up strategy with regard to clinical outcomes for the patient and with regard to cost-effectiveness (direct cost per patient to achieve clinical success). This superiority was robust within the plausible range of probabilities according to the sensitivity analyses.
  
  
  CONCLUSIONS
  The PPI-first strategy is superior to the H2RA-first "step-up" strategy with regard to both efficacy and cost-effectiveness and therefore, the PPI-first strategy is the preferred therapeutic approach for the acute medical treatment of reflux esophagitis.
authors.affiliation: Department of Gastroenterology, Saiseikai-Noe Hospital, 2-2-33 Imafuku-Higashi Joto-ku, Osaka 536-0002, Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Habu
authors.forename: Kazuo
authors.initials: K
authors.lastname: Maeda
authors.forename: Takeo
authors.initials: T
authors.lastname: Kusuda
authors.forename: Takuya
authors.initials: T
authors.lastname: Yoshino
authors.forename: Seiji
authors.initials: S
authors.lastname: Shio
authors.forename: Maki
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Takanobu
authors.initials: T
authors.lastname: Hayakumo
authors.forename: Kyohei
authors.initials: K
authors.lastname: Hayashi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kawai
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004942:Esophagitis, Peptic / Q000188:drug therapy* / Q000191:economics*; D006635:Histamine H2 Antagonists / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007564:Japan; D064747:Lansoprazole; D015233:Models, Statistical; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D011899:Ranitidine / Q000191:economics / Q000627:therapeutic use*
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D011899:Ranitidine; D009853:Omeprazole