Journal of Gastroenterology

, Volume 40, Issue 11, pp 1029–1035

“Proton-pump inhibitor-first” strategy versus “step-up” strategy for the acute treatment of reflux esophagitis: a cost-effectiveness analysis in Japan

  • Yasuki Habu
  • Kazuo Maeda
  • Takeo Kusuda
  • Takuya Yoshino
  • Seiji Shio
  • Maki Yamazaki
  • Takanobu Hayakumo
  • Kyohei Hayashi
  • Yoshiyuki Watanabe
  • Keiichi Kawai
Article

DOI: 10.1007/s00535-005-1704-y

Cite this article as:
Habu, Y., Maeda, K., Kusuda, T. et al. J Gastroenterol (2005) 40: 1029. doi:10.1007/s00535-005-1704-y

Abstract

Background

Gastroesophageal reflux disease (GERD) is a common condition, and acid-suppressing agents are the mainstays of treatment. For the acute medical management of GERD, two different strategies can be proposed: either the most effective therapy, i.e., proton-pump inhibitors (PPIs), can be given first, or histamine H2-receptor antagonists (H2RAs) can be attempted first (the “step-up” approach).

Methods

A clinical decision analysis comparing the PPI-first strategy and the H2RA-first “step-up” strategy for the acute treatment of reflux esophagitis in Japan was performed, using a Markov chain approach.

Results

The PPI-first strategy was consistently superior to the step-up strategy with regard to clinical outcomes for the patient and with regard to cost-effectiveness (direct cost per patient to achieve clinical success). This superiority was robust within the plausible range of probabilities according to the sensitivity analyses.

Conclusions

The PPI-first strategy is superior to the H2RA-first “step-up” strategy with regard to both efficacy and cost-effectiveness and therefore, the PPI-first strategy is the preferred therapeutic approach for the acute medical treatment of reflux esophagitis.

Key words

cost-effectiveness gastroesophageal reflux disease lansoprazole proton pump inhibitor reflux esophagitis 

Copyright information

© Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Yasuki Habu
    • 1
    • 2
  • Kazuo Maeda
    • 1
  • Takeo Kusuda
    • 1
  • Takuya Yoshino
    • 1
  • Seiji Shio
    • 1
  • Maki Yamazaki
    • 1
    • 2
  • Takanobu Hayakumo
    • 1
    • 2
  • Kyohei Hayashi
    • 3
  • Yoshiyuki Watanabe
    • 3
  • Keiichi Kawai
    • 2
    • 4
  1. 1.Department of GastroenterologySaiseikai-Noe HospitalOsakaJapan
  2. 2.Digestive Clinical Outcomes Research GroupOsakaJapan
  3. 3.Department of Epidemiology for Community Health and MedicineKyoto Prefectural University of Medicine Graduate School of Medical ScienceKyotoJapan
  4. 4.Department of Internal MedicineYukawa Gastrointestinal HospitalOsakaJapan

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