"Proton-pump inhibitor-first" strategy versus "step-up" strategy for the acute treatment of reflux esophagitis: a cost-effectiveness analysis in Japan

• Published in: Journal of gastroenterology 2005-11, Vol.40 (11), p.1029-1035
• Main Authors: Habu, Yasuki, Maeda, Kazuo, Kusuda, Takeo, Yoshino, Takuya, Shio, Seiji, Yamazaki, Maki, Hayakumo, Takanobu, Hayashi, Kyohei, Watanabe, Yoshiyuki, Kawai, Keiichi
• Format: Article
• Language: English
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Ulcer Agents - economics; Anti-Ulcer Agents - therapeutic use; Cost analysis; Cost-Benefit Analysis; Decision Support Techniques; Esophagitis; Esophagitis, Peptic - drug therapy; Esophagitis, Peptic - economics; Gastroesophageal reflux; Histamine; Histamine H2 Antagonists - economics; Histamine H2 Antagonists - therapeutic use; Humans; Japan; Lansoprazole; Markov chains; Medical treatment; Models, Statistical; Omeprazole - analogs & derivatives; Omeprazole - economics; Omeprazole - therapeutic use; Patients; Proton Pump Inhibitors; Ranitidine - economics; Ranitidine - therapeutic use; Sensitivity analysis
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-005-1704-y

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). 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. 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. 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.