PharmacoEconomics

, Volume 23, Issue 10, pp 1031–1041 | Cite as

Economic analysis of on-demand maintenance therapy with proton pump inhibitors in patients with non-erosive reflux disease

  • Dyfrig A. Hughes
  • Keith Bodger
  • Peter Bytzer
  • Dirk de Herdt
  • Dominique Dubois
Original Research Article

Abstract

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.

Keywords

Omeprazole Lansoprazole Esomeprazole Pantoprazole Rabeprazole 

Notes

Acknowledgements

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.

References

  1. 1.
    Kennedy T, Jones R. The prevalence of gastro-oesophageal reflux symptoms in a UK population and the consultation behaviour of patients with these symptoms. Aliment Pharmacol Ther 2000; 14: 1589–94PubMedCrossRefGoogle Scholar
  2. 2.
    Ofman JJ. The economic and quality-of-life impact of symptomatic gastroesophageal reflux disease. Am J Gastroenterol 2003; 98 (3 Suppl.): S8–S14PubMedCrossRefGoogle Scholar
  3. 3.
    Jaspersen D, Kulig M, Labenz J, et al. Prevalence of extra-oesophageal manifestations in gastro-oesophageal reflux disease: an analysis based on the ProGERD Study. Aliment Pharmacol Ther 2003; 17: 1515–20PubMedCrossRefGoogle Scholar
  4. 4.
    Fass R, Fennerty MB, Vakil N. Nonerosive reflux disease: current concepts and dilemmas. Am J Gastroenterol 2001; 96: 303–14PubMedGoogle Scholar
  5. 5.
    Dent J, Jones R, Kahrilas P, et al. Management of gastro-oesophageal reflux disease in general practice. BMJ 2001; 322: 344–7PubMedCrossRefGoogle Scholar
  6. 6.
    Inadomi JM. On-demand and intermittent therapy for gastro-oesophageal reflux disease: economic considerations. Pharma-coeconomics 2002; 20: 565–76CrossRefGoogle Scholar
  7. 7.
    Wahlqvist P, Junghard O, Higgins A, et al. Cost effectiveness of proton pump inhibitors in gastro-oesophageal reflux disease without oesophagitis: comparison of on-demand esomeprazole with conventional omeprazole strategies. Pharmacoeconomics 2002; 20: 267–77PubMedCrossRefGoogle Scholar
  8. 8.
    Talley NJ, Venables TL, Green JR, et al. Esomeprazole 40mg and 20mg is efficacious in the long-term management of patients with endoscopy-negative gastro-oesophageal reflux disease: a placebo-controlled trial of on-demand therapy for 6 months. Eur J Gastroenterol Hepatol 2002; 14: 857–63PubMedCrossRefGoogle Scholar
  9. 9.
    Talley NJ, Lauritsen K, Tunturi-Hihnala H, et al. Esomeprazole 20mg maintains symptom control in endoscopy-negative gastro-oesophageal reflux disease: a controlled trial of ‘on-demand’ therapy for 6 months. Aliment Pharmacol Ther 2001; 15: 347–54PubMedCrossRefGoogle Scholar
  10. 10.
    Cooper AL, Baxter G. Efficacy of lansoprazole on demand therapy in the treatment of non-erosive reflux disease and functional ulcer-like dyspepsia [abstract]. Gut 2003; 52 Suppl. VI: A137Google Scholar
  11. 11.
    Lind T, Havelund T, Lundell L, et al. On demand therapy with omeprazole for the long-term management of patients with heartburn without oesophagitis: a placebo-controlled randomised trial. Aliment Pharmacol Ther 1999; 13: 907–14PubMedCrossRefGoogle Scholar
  12. 12.
    Scholten T, Dekkers CPM, Schulze K, et al. On-demand therapy with pantoprazole 20mg as effective long-term management of reflux disease in patients with mild GERD: the ORION trial [abstract]. Gut 2002; 51 Suppl. III: A165Google Scholar
  13. 13.
    Kaspari S, Kupcinskas L, Fischer R, et al. On-demand therapy with pantoprazole 20mg as effective long-term management of patients suffering from mild GERD. Gastroenterology 2003; 124 (4 Suppl. 1): A538CrossRefGoogle Scholar
  14. 14.
    Bytzer P, Blum AL, de Herdt D, et al. On-demand rabeprazole therapy provides heartburn control in long-term management of nonerosive reflux disease (NERD). Aliment Pharmacol Ther 2004; 19: 181–8CrossRefGoogle Scholar
  15. 15.
    Kartman B, Gatz G, Johannesson M. Health state utilities in GERD patients with heartburn: a study in Germany and Sweden. Med Decis Making 2004; 23: 40–52CrossRefGoogle Scholar
  16. 16.
    The EuroQol Group. EuroQol: a new facility for the measurement of health-related quality of life. Health Policy 1990; 16: 199–208CrossRefGoogle Scholar
  17. 17.
    Kind P, Hardman G, Macran S. UK Population norms for EQ5D. York Centre for Health Economics Discussion Paper 1999 Nov, 172Google Scholar
  18. 18.
    Bodger K, Eastwood PG, Manning SE et al. Dyspepsia workload in urban general practice and implications of the British Society of Gastroenterology Dyspepsia Guidelines (1996). Aliment Pharmacol Ther 2000; 14: 413–20PubMedCrossRefGoogle Scholar
  19. 19.
    Department of Health. Drug tariff. London: The Stationary Office, 2003Google Scholar
  20. 20.
    Netten A, Rees T, Harrison G. Unit costs of health and social care 2001. Kent, UK: University of Kent at Canterbury, Personal Social Services Research Unit, 2001Google Scholar
  21. 21.
    Goeree R, O’Brien B, Hunt R, et al. Economic evaluation of long term management strategies for erosive oesophagitis. Pharmacoeconomics 1999; 16: 679–97PubMedCrossRefGoogle Scholar
  22. 22.
    Gerson LB, Robbins AS, Garber A, et al. A cost-effectiveness analysis of prescribing strategies in the management of gastroesophageal reflux disease. Am J Gastroenterol 2000; 95: 395–407PubMedCrossRefGoogle Scholar
  23. 23.
    Harris RA, Kuppermann M, Richter JE. Prevention of recurrences of erosive reflux esophagitis: a cost-effectiveness analysis of maintenance proton pump inhibition. Am J Med 1997; 102: 78–88PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Dyfrig A. Hughes
    • 1
  • Keith Bodger
    • 2
  • Peter Bytzer
    • 3
  • Dirk de Herdt
    • 4
  • Dominique Dubois
    • 5
  1. 1.Centre for the Economics of Health, IMSCaRUniversity of Wales, BangorBangorUK
  2. 2.Department of Medicine, Clinical Sciences CentreUniversity Hospital AintreeLiverpoolUK
  3. 3.Department of Medical GastroenterologyGlostrup University HospitalGlostrupDenmark
  4. 4.Medical Affairs, Janssen-Cilag EMEA, a division of Janssen Pharmaceutica N.V.BeerseBelgium
  5. 5.Johnson & Johnson Pharmaceutical Services, c/o Janssen Pharmaceutica N.V.BeerseBelgium

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