Cost effectiveness of rabeprazole versus generic ranitidine for symptom resolution in patients with erosive esophagitis

Objective: To compare the cost effectiveness of rabeprazole (RAB) and ranit idine (RAN) in acute and maintenance therapy for erosive esophagitis using symptom response, rather than endoscopic healing, as the clinical outcome. Study Design: Decision analysis was used to model the cost effectiveness of competing therapies based on the results of clinical trials of RAB versus RAN and estimates from the medical literature. Methods: The model's base case scenario compared brand-name RAB (estimated average wholesale price) with generic RAN (25% of the average wholesale pri ce of brand-name RAN). Medical costs for hospitalizations, procedures, and office visits reflected 1998 Medicare payments. The 1-year maintenance mode l accounted for drug-class switching and symptomatic, rather than endoscopi c, recurrences, Effectiveness was reported as the percentage of patients in whom a symptomatic recurrence was prevented. The cost per symptomatic recu rrence prevented was reported as an average and an incremental cost-effecti veness ratio. Results: The per-patient cost of RAB therapy was higher than that of RAN th erapy ($2020 vs $1917); RAB therapy, however, was more effective than RAN t herapy in preventing symptomatic recurrences (74% vs 41%). The average cost -effectiveness ratio was lower for RAB therapy than for RAN therapy ($2748 per symptomatic recurrence prevented vs $4719 per symptomatic recurrence pr evented). The cast of preventing one additional symptomatic recurrence with RAB rather than RAN was $313 (incremental cost-effectiveness ratio). Sensi tivity analysis conducted on key clinical and cost variables supported the robustness of the decision model. Conclusion: This analysis demonstrates that management of esophagitis with RAB is more effective, and may be more cost effective, than management with generic RAN, despite RAB's higher per-unit cost.