Economic analysis of on-demand maintenance therapy with proton pump inhibitors in patients with non-erosive reflux disease
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Aim: 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 (€, 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 and 0.89 for rabeprazole 10mg; €176 and 0.90 for pantoprazole 20mg; €190 and 0.89 for esomeprazole 20mg; €195 and 0.91 for lansoprazole 15mg; €201 and 0.90 for omeprazole 20mg; and €210 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.
KeywordsOmeprazole Lansoprazole Esomeprazole Pantoprazole Rabeprazole
Contributors: Dyfrig A. Hughes conducted the economic modelling and will act as guarantor for the paper. Keith Bodger, Dirk de Herdt and Peter Bytzer provided clinical input and supplied data for the analysis. Dyfrig A. Hughes, Keith Bodger, Peter Bytzer and Dominique Dubois contributed to drafting the manuscript.
Funding: Janssen Pharmaceutica N.V., Belgium.
Competing interests: Dyfrig A. Hughes has received research funding from Janssen Pharmaceutica N.V., Belgium. Dominique Dubois and Dirk de Herdt are employed by, and are shareholders of, Johnson & Johnson. Keith Bodger and Peter Bytzer have previously received hospitality from manufacturers of proton pump inhibitors.
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