Cost-utility analysis of a ‘vonoprazan-first’ strategy versus ‘esomeprazole- or rabeprazole-first’ strategy in GERD

  • Yuta Yokoya
  • Ataru Igarashi
  • Akihito Uda
  • Hisato Deguchi
  • Toshihisa TakeuchiEmail author
  • Kazuhide Higuchi
Original Article—Alimentary Tract



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.


Cost-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).

Author contributions

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.

Supplementary material

535_2019_1609_MOESM1_ESM.docx (13 kb)
Supplementary file1 (DOCX 13 kb)


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Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Second Department of Internal MedicineOsaka Medical CollegeTakatsukiJapan
  2. 2.Unit of Public Health and Preventive Medicine, School of MedicineYokohama City UniversityYokohamaJapan
  3. 3.Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical SciencesThe University of TokyoTokyoJapan
  4. 4.Japan Medical AffairsTakeda Pharmaceutical Company LimitedTokyoJapan

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