Economic analysis of on-demand maintenance therapy with proton pump inhibitors in patients with non-erosive reflux disease

Aim: To evaluate the costs and effectiveness of on-demand maintenance therapy with oral esomeprazole, lansoprazole, omeprazole, pantoprazole or rabeprazole in patients with endoscopy-confirmed non-erosive reflux disease (NERD) in the UK. Methods: A probabilistic model was developed to compare the costs and effectiveness of five proton pump inhibitors (PPIs) in endoscopy-negative, symptomatic NERD patients who had complete resolution of heartburn symptoms following 4 weeks of open-label acute PPI treatment. The total annual expected costs (€, 2003 values) and utilities gained per patient were measured over a 1-year horizon from the perspective of the UK NHS. Model uncertainty was addressed by sensitivity analyses. Results: The base-case annual median costs and utilities gained with on-demand PPI therapy were: €123 and 0.89 for rabeprazole 10mg; €176 and 0.90 for pantoprazole 20mg; €190 and 0.89 for esomeprazole 20mg; €195 and 0.91 for lansoprazole 15mg; €201 and 0.90 for omeprazole 20mg; and €210 and 0.91 for omeprazole 10mg. Differences in costs, but not in outcomes, were statistically significant. The results were robust to sensitivity analyses. Conclusions: In this analysis, on-demand use of rabeprazole for the management of NERD incurred the least cost in comparison with the other PPIs evaluated. Utility gains were comparable for all on-demand PPIs. The place of on-demand PPIs in therapy, however, requires further evaluation.