title: Cost minimization of on-demand maintenance therapy with proton pump inhibitors in nonerosive gastroesophageal reflux disease.
abstract: On-demand proton pump inhibitor maintenance therapy is one of the suggested strategies for patients with nonerosive gastroesophageal reflux disease who achieve symptom remission after 4 weeks of continuous treatment. This review evaluates the difference in cost and quality of life of six on-demand proton pump inhibitor maintenance strategies in patients with nonerosive gastroesophageal reflux disease. This was performed by decision analysis and Markov modeling of costs (from the perspective of the healthcare service and society) and utility up to 12 months. Median utility scores associated with each proton pump inhibitor ranged from 0.731 to 0.745 quality-adjusted life years and were not statistically different. Annual expected cost, however, was statistically different among the different drugs and the following cost-minimization ranking was obtained for median costs to the healthcare service and society, respectively: rabeprazole (euro 181, euro 295), pantoprazole (euro 223, euro 341), lansoprazole (euro 249, euro 370), omeprazole 10 mg (euro 297, euro 412), esomeprazole (euro 295, euro 419) and omeprazole 20 mg (euro 405, euro 528). Unit cost of proton pump inhibitors was the major determinant of cost to the healthcare service, while the number of productivity days lost due to symptoms was the major determinant of cost to society. In Italy, on-demand use of rabeprazole for maintenance therapy of nonerosive gastroesophageal reflux disease incurs the least cost in comparison with the other proton pump inhibitors evaluated.
authors.affiliation: University of Wales, Institute of Medical and Social Care Research, Bangor, Deiniol Street, Bangor, LL57 2UW, UK. d.a.hughes@bangor.ac.uk
authors.forename: Dyfrig A
authors.initials: DA
authors.lastname: Hughes
authors.forename: Monia
authors.initials: M
authors.lastname: Marchetti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Colombo