Cost-utility analysis of a ‘vonoprazan-first’ strategy versus ‘esomeprazole- or rabeprazole-first’ strategy in GERD
- 205 Downloads
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.
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.
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.
Vonoprazan-first strategy increased QALYs and appeared to be cost-effective for GERD patients compared with the esomeprazole- or rabeprazole-first strategies.
KeywordsCost-utility analysis Gastroesophageal reflux disease Proton-pump inhibitor Vonoprazan
The authors would like to thank Kazuo Ueda, PhD, at the time employed by Takeda Pharmaceutical Co., Ltd., for his contribution to the study design and interpretation of the data. Support in the data analyses was provided, under the direction of the authors, by Sachie Inoue, PhD, an employee of Crecon Medical Assessment. Writing support was provided by Mark Richardson, on behalf of FireKite, and Sabah Farooq of FireKite, an Ashfield company, part of UDG Healthcare plc, during the development of this manuscript, which was funded by Takeda Pharmaceutical Co. Ltd. (Tokyo, Japan), and complied with Good Publication Practice 3 ethical guidelines (Battisti et al., Ann Intern Med. 2015;163:461–464).
YY: Study conception and design, interpretation of the study data and data analysis, critical revision of the paper, approved the final draft submitted. AI: Study conception and design, interpretation of the study data and data analysis, critical revision of the paper, approved the final draft submitted. AU: Study conception and design, data collection and assembly, interpretation of the study data and data analysis, critical revision of the paper, approved the final draft submitted. HD: Study conception and design, critical revision of the paper, approved the final draft submitted. TT: Interpretation of the study data and data analysis, critical revision of the paper, approved the final draft submitted. KH: Study conception and design, interpretation of the study data and data analysis, critical revision of the paper, approved the final draft submitted.
For this research was provided by Japan Medical Affairs, Takeda Pharmaceutical Company Limited, Tokyo, Japan.
Compliance with ethical standards
Conflict of interest
Ataru Igarashi received consulting fees from Novartis Pharma K. K., AbbVie GK, Milliman, Sony Inc., and Eli Lilly Japan K. K., and lecture fees from Chugai Pharmaceutical Company, Ltd., CRECON Research and Consulting Inc., Terumo Corporation, Bristol-Myers Squibb K. K., and Creativ Ceutical K. K. Ataru Igarashi also received research grants from Pfizer Japan Inc., CSL Behring Japan Inc., Gilead Science K. K., and Fuji Film K. K. Akihito Uda and Hisato Deguchi are employees of Takeda Pharmaceutical Company Ltd. Toshihisa Takeuchi received honoraria from AstraZeneca K.K., Daiichi Sankyo Company, Ltd., and Takeda Pharmaceutical Company, Ltd. Toshihisa Takeuchi also received research funding from AstraZeneca K.K. Kazuhide Higuchi received research honoraria and research funding from Takeda Pharmaceutical Company, Ltd., Otsuka Pharmaceutical Company, Ltd., AstraZeneca K.K., Daiichi Sankyo Company, Ltd., and Eisai Company, Ltd. Yuta Yokoya has no conflicts of interest to declare.
- 10.Kimiya T. The association between persistent reflux symptoms and health-related quality of life in Japanese patients with gastroesophageal reflux disease. Jpn J Psychosom Med. 2017;57:357–61.Google Scholar
- 12.Hori Y, Imanishi A, Matsukawa J, et al. 1-[5-(2-Fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl]-N-methylmethanamin e monofumarate (TAK-438), a novel and potent potassium-competitive acid blocker for the treatment of acid-related diseases. J Pharmacol Exp Ther. 2010;335:231–8.CrossRefGoogle Scholar
- 26.Takeda Pharmaceutical Company Ltd. Comparison of vonoprazan to esomeprazole in participants with symptomatic GERD who responded partially to a high dose of proton pump inhibitor (PPI). ClinicalTrials.gov: US NIH; 2018. https://clinicaltrials.gov/ct2/show/NCT02743949. Accessed 24 Apr 2019.
- 27.Takeda Pharmaceutical Company Ltd. Efficacy and safety of oral once-daily vonoprazan (TAK-438) in participants with erosive esophagitis. ClinicalTrials.gov: US NIH; 2017. https://clinicaltrials.gov/ct2/show/NCT02388724. Accessed 24 Apr 2019.
- 34.Higuchi K, Uda A, Deguchi H, et al. Su1016 - Cost-utility analysis of potassium-competitive acid blocker-based therapeutic strategy for gastroesophageal reflux disease compared with proton-pump inhibitor-based therapeutic strategy [abstract]. Gastroenterology. 2018;154:S455–S456456.CrossRefGoogle Scholar
- 35.Sugano K, Kobayashi SS. Cost-effectiveness analysis of maintenance therapies for reflux esophagitis–comparison between step-up therapies and step-down therapies. Jpn Pharmacol Ther. 2001;29:459–68.Google Scholar
- 37.Miwa H, Igarashi A, Teng L, et al. Systematic review with network meta-analysis: indirect comparison of the efficacy of vonoprazan and proton-pump inhibitors for maintenance treatment of gastroesophageal reflux disease. J Gastroenterol. 2019. https://doi.org/10.1007/s00535-019-01572-y.Google Scholar
- 38.Pharmaceutical Industry Association. Insurance medicine encyclopedia plus (30th edition) [in Japanese]. 2018.Google Scholar
- 39.Medical Correspondent Company. Medical care quick-point reference chart [in Japanese]. 2018.Google Scholar
- 40.Central Social Insurance Medical Council. Analysis guidelines for cost-effectiveness assessment [in Japanese]. Tokyo, Japan: Health, Labor and Welfare Science Research Grants; 2015. https://www.mhlw.go.jp/file/05-Shingikai-12404000-Hokenkyoku-Iryouka/0000104722.pdf. Accessed 24 Apr 2019.
- 41.Grant A, Wileman S, Ramsay C, et al. The effectiveness and cost-effectiveness of minimal access surgery amongst people with gastro-oesophageal reflux disease—a UK collaborative study The REFLUX trial. Health Technol Assess. 2008;12(1–181):iii–iv.Google Scholar
- 42.Ministry of Health Labour and Welfare. Study on cost-effectiveness evaluation [in Japanese]. Tokyo, Japan2018. https://www.mhlw.go.jp/content/12404000/000435621.pdf. Accessed 24 Apr 2019.
- 44.Habu Y. Vonoprazan versus lansoprazole for the initial treatment of reflux esophagitis: a cost-effectiveness analysis in Japan. Intern Med. 2019; doi:10.2169/internalmedicine.2535-18.Google Scholar
- 46.Takeuchi T, Hongo H, Kimura T, et al. Efficacy and safety of hangeshashinto for treatment of GERD refractory to proton pump inhibitors : usual dose proton pump inhibitors plus hangeshashinto versus double-dose proton pump inhibitors: randomized, multicenter open label exploratory study. J Gastroenterol. 2019. https://doi.org/10.1007/s00535-019-01588-4.Google Scholar
- 47.Ozaki H, Harada S, Takeuchi T, et al. Vonoprazan, a novel potassium-competitive acid blocker, should be used for the Helicobacter pylori eradication therapy as first choice: a large sample study of vonoprazan in real world compared with our randomized control trial using second-generation proton pump inhibitors for Helicobacter pylori eradication therapy. Digestion. 2018;97:212–8.CrossRefGoogle Scholar