Cost-utility analysis of a 'vonoprazan-first' strategy versus 'esomeprazole- or rabeprazole-first' strategy in GERD.

Abstract

BACKGROUND:

Gastroesophageal reflux disease (GERD) can be treated using a vonoprazan-first strategy (first-line treatment with vonoprazan), or esomeprazole-first/rabeprazole-first strategies (first-line treatment with proton-pump inhibitors [PPIs], esomeprazole/rabeprazole, followed by a switch to vonoprazan). This cost-utility analysis used long-term simulation modeling to evaluate the cost-effectiveness of a vonoprazan-first strategy compared with the esomeprazole-first and rabeprazole-first strategies.

METHODS:

A Markov simulation model was developed to evaluate the cost-effectiveness of vonoprazan-first, esomeprazole-first, and rabeprazole-first strategies, comprising healing and maintenance therapies, over 5 years (4-week cycles). Healing therapy began with the administration of a normal dose of drug per real-world practice. If patients were not healed endoscopically, either a longer duration of healing therapy was provided (vonoprazan), the dose was increased (rabeprazole), or patients were switched to vonoprazan (immediately for esomeprazole, and after dose-escalation for rabeprazole, respectively). Healed patients received maintenance (lower/same dose as healing therapy). Recurrence resulted in re-challenge with healing therapy. Transition probabilities were derived from the results of indirect comparisons (network meta-analysis) and costs calculated from the Japanese payer perspective. Outcomes were defined as quality-adjusted life years (QALYs), with utilities based on published values.

RESULTS:

Expected costs of the vonoprazan-, esomeprazole-, and rabeprazole-first strategies were ¥36,194, ¥76,719, and ¥41,105, respectively, over 5 years. QALY gains for vonoprazan-first strategy versus the esomeprazole- and rabeprazole-first strategies were 0.014 and 0.003, respectively. Both estimated incremental cost-effectiveness ratios were dominant and robust to two sensitivity analyses.

CONCLUSIONS:

Vonoprazan-first strategy increased QALYs and appeared to be cost-effective for GERD patients compared with the esomeprazole- or rabeprazole-first strategies.

• Authors: Yuta Yokoya, Ataru Igarashi, Akihito Uda, Hisato Deguchi, Toshihisa Takeuchi, Kazuhide Higuchi
• Journal: Journal of gastroenterology (J Gastroenterol) Vol. 54 Issue 12 Pg. 1083-1095 (Dec 2019) ISSN: 1435-5922 [Electronic] Japan
• PMID: 31396703 (Publication Type: Comparative Study, Journal Article)

Chemical References

• 1-(5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl)-N-methylmethanamine
• Proton Pump Inhibitors
• Pyrroles
• Sulfonamides
• Rabeprazole
• Esomeprazole

Topics

• Computer Simulation
• Cost-Benefit Analysis
• Esomeprazole (administration & dosage, economics)
• Gastroesophageal Reflux (drug therapy, economics)
• Humans
• Japan
• Markov Chains
• Proton Pump Inhibitors (administration & dosage, economics)
• Pyrroles (administration & dosage, economics)
• Quality-Adjusted Life Years
• Rabeprazole (administration & dosage, economics)
• Recurrence
• Sulfonamides (administration & dosage, economics)
• Time Factors
• Treatment Outcome