Cost-utility analysis of a ‘vonoprazan-first’ strategy versus ‘esomeprazole- or rabeprazole-first’ strategy in GERD

Yokoya, Yuta; Igarashi, Ataru; Uda, Akihito; Deguchi, Hisato; Takeuchi, Toshihisa; Higuchi, Kazuhide

doi:10.1007/s00535-019-01609-2

Cited by 20 publications

(14 citation statements)

References 45 publications

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“…A recent pharmacoeconomic analysis focused on the acute‐phase treatment of reflux esophagitis demonstrated that VPZ appears to be the drug of choice, and the model structure in this analysis formed the basis of that used in the present study 20 . A cost‐utility analysis comparing VPZ versus esomeprazole or rabeprazole has been published 38 . In this analysis, compared strategies were limited to continuous maintenance therapies, although the majority of erosive esophagitis is mild type, such as Los Angeles classification grade A or B.…”

Section: Discussionmentioning

confidence: 99%

“…It is therefore reasonable that the analyses include the costs and consequences that may be borne by the patient 15 . Several studies have employed cost‐utility analyses using quality‐adjusted life years as the outcome measure 35–38 . These studies have indicated that the utility value of a health state associated with GERD symptoms has a great impact on results, and is the key determinant for deciding cost‐effectiveness.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the adopted utility values among those studies varied widely. For example, the utility value for the state with symptoms of GERD surprisingly varied from 0.97 to 0.56 35–38 . In this study, to incorporate the patients' views or preferences, the monthly medical bills (co‐payment) for patients covered by health insurance were evaluated.…”

Section: Discussionmentioning

confidence: 99%

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Treatment strategies for reflux esophagitis including a potassium‐competitive acid blocker: A cost‐effectiveness analysis in Japan

Habu¹,

Hamasaki²,

Maruo³

et al. 2021

J of Gen and Family Med

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Introduction Gastroesophageal reflux disease is a common condition, and proton pump inhibitors (PPIs) are the mainstays of treatment. However, concerns have been raised about the safety of PPIs. A potassium‐competitive acid blocker (P‐CAB), vonoprazan (VPZ), was recently introduced, which may provide clinical benefits. This study was performed to investigate the cost‐effectiveness of alternative long‐term strategies including continuous and discontinuous treatment with VPZ for the management of reflux esophagitis in Japan. Methods A health state transition model was developed to capture the long‐term management of reflux esophagitis. Four different strategies were compared: (a) intermittent PPI using lansoprazole (LPZ); (b) intermittent P‐CAB; (c) maintenance PPI using LPZ; and (d) maintenance P‐CAB. Results Intermittent P‐CAB was the most cost‐effective, and the number of days for which medication was required with this strategy was fewest. Maintenance PPI was more efficacious, but more costly than intermittent P‐CAB. Maintenance P‐CAB was more efficacious, but more costly than maintenance PPI. Co‐payments were higher for maintenance PPI than for intermittent P‐CAB, and for maintenance P‐CAB than for maintenance PPI, which were considered reasonable for the majority of patients to improve symptoms. Conclusions Intermittent P‐CAB appears to be the strategy of choice for the majority of reflux esophagitis patients in clinical practice. If a patient is not satisfied with the symptom control of the current strategy, switching to a more effective strategy appears to be a reasonable option for the majority of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Treatment strategies for reflux esophagitis including a potassium‐competitive acid blocker: A cost‐effectiveness analysis in Japan

Habu¹,

Hamasaki²,

Maruo³

et al. 2021

J of Gen and Family Med

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“…Considering the cost of long‐term medication and potential adverse reactions, maintenance therapy should be selected based on its overall efficacy, safety, medical cost, medication preference and dosing frequency. To achieve symptom relief and endoscopic mucosal healing, PPI and P‐CAB are the most economical and effective options, 83,84 while on‐demand treatment can manage the symptoms of NERD and mild esophagitis, especially the former. An RCT including 598 patients with NERD showed that while considering patient compliance, on‐demand PPI treatment was non‐inferior to daily treatment and effectively improved heartburn and regurgitation in 82.1% of patients at a much lower dose compared with daily treatment 85 .…”

Section: Introductionmentioning

confidence: 99%

Chinese expert consensus on gastroesophageal reflux disease in 2020

Xiao

Zhou

Hou

et al. 2021

J of Digest Diseases

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“…Since the speed of healing and resolution of GERD symptoms in patients with reflux esophagitis depends on the acid-secretory inhibitory properties of drugs, the use of potent acid-secretory inhibitors is recommended for treatment [5]. It is important to administer rapid, continuous, and potent acid suppression for 24 h at an early stage, followed by a minimum level of acid suppression in consideration of symptoms and recurrence of esophageal mucosal injury [6,7]. However, high-dose proton pump inhibitors (PPIs) have not been shown to improve GERD symptoms in patients with NERD who do not respond to acid-secretory medications [8,9].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of endoscopic submucosal dissection for gastroesophageal reflux disease (ESD-G) for medication-refractory gastroesophageal reflux disease: 35 cases underwent ESD-G including 15 cases followed more than 5 years

Takeuchi

Kojima

et al. 2021

BMC Gastroenterol

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Background Although some kinds of endoluminal surgery for patients with proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) have been reported, there are few reports on their long-term outcomes. In 2014, we reported the effectiveness of endoscopic surgery for PPI-refractory GERD, which we invented and named endoscopic submucosal dissection for GERD (ESD-G) in 2008. Thereafter, we accumulated more cases and monitored the patients’ condition postoperatively and describe the outcomes herein. Patients and methods This single-center, single-arm trial was conducted at the Osaka Medical and Pharmaceutical University Hospital. We compared outcomes between before and 3–6 months after ESD-G. Additionally, we investigated the outcomes of patients 5 or more years after ESD-G. Results We performed 42 ESD-G procedures in 35 patients between 2008 and 2020. In seven patients, ESD-G was performed twice for various reasons. The frequency scale for the symptoms of GERD score was significantly improved 3–6 months after ESD-G (22 → 10, p < 0.0001); the Los Angeles classification for reflux esophagitis was clearly improved after ESD-G (p = 0.0423). The number of reflux episodes was not decreased by ESD-G. There was a significant difference in the potency unit of gastric acid secretion suppressants for controlling GERD-related symptoms between baseline and 3–6 months after ESD-G (p = 0.0009). In patients without a history of distal gastrectomy who underwent ESD-G, the potency unit of gastric acid secretion suppressants significantly decreased 5 or more years after ESD-G (p = 0.0121). Conclusion ESD-G may be effective in patients with refractory GERD-related symptoms without a history of distal gastrectomy.

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Cost-utility analysis of a ‘vonoprazan-first’ strategy versus ‘esomeprazole- or rabeprazole-first’ strategy in GERD

Cited by 20 publications

References 45 publications

Treatment strategies for reflux esophagitis including a potassium‐competitive acid blocker: A cost‐effectiveness analysis in Japan

Treatment strategies for reflux esophagitis including a potassium‐competitive acid blocker: A cost‐effectiveness analysis in Japan

Chinese expert consensus on gastroesophageal reflux disease in 2020

Outcomes of endoscopic submucosal dissection for gastroesophageal reflux disease (ESD-G) for medication-refractory gastroesophageal reflux disease: 35 cases underwent ESD-G including 15 cases followed more than 5 years

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