PROTON PUMP INHIBITORS OR HISTAMINE-2 RECEPTOR ANTAGONISTS FOR THE PREVENTION OF RECURRENCES OF EROSIVE REFLUX ESOPHAGITIS - A COST-EFFECTIVENESS ANALYSIS

Objectives: Erosive esophagitis is a recurring condition for which man y patients require preventive therapy, If maintenance therapy must be provided, the most cost-effective treatment strategy should be establi shed, We evaluated the costs and benefits associated with three treatm ent strategies: 1) maintenance therapy with a proton pump inhibitor (P PI) strategy, 2) maintenance therapy with a high-dose histamine-2 rece ptor antagonist (H2RA) strategy, and 3) maintenance therapy with a sta ndard-dose H2RA, If patients experience a symptomatic recurrence on th e H2RA strategies, they then receive PPI maintenance, Methods: We used a cost-effectiveness model with a 1-yr time frame; data were obtained from randomized trials of lansoprazole and ranitidine, from case seri es, and expert opinion, Results: In most situations, the high-dose H2R A strategy is the most costly, yet it is less effective than the PPI s trategy. Among the remaining two options, the PPI strategy is more cos tly and more effective than the standard-dose H2RA strategy, requiring an additional $52-688 per recurrence prevented, depending on drug acq uisition costs, The greater the degree to which esophagitis decreases quality of life, the more cost effective is the PPI strategy, For exam ple, with a $50,000 per quality-adjusted life year cost-effectiveness threshold and a market-weighted average of drug costs, the PPI strateg y appears cost effective for those patients who report that symptoms o f esophagitis cause greater than a 9% decrement in quality of life, Co nclusions: The high-dose H2RA strategy is not preferred in terms of ei ther costs or benefits, The PPI strategy appears cost effective relati ve to the standard-dose H2RA strategy in the following situations: whe n patients are significantly bothered by esophagitis and in institutio nal settings where the difference in drug costs between PPIs and H2RAs is small.