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

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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.

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Authors and Affiliations

  1. Department of Gastroenterology, Saiseikai-Noe Hospital, 2-2-33 Imafuku-Higashi Joto-ku, Osaka, 536-0002, Japan

    Yasuki Habu, Kazuo Maeda, Takeo Kusuda, Takuya Yoshino, Seiji Shio, Maki Yamazaki & Takanobu Hayakumo

  2. Digestive Clinical Outcomes Research Group, Osaka, Japan

    Yasuki Habu, Maki Yamazaki, Takanobu Hayakumo & Keiichi Kawai

  3. Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan

    Kyohei Hayashi & Yoshiyuki Watanabe

  4. Department of Internal Medicine, Yukawa Gastrointestinal Hospital, Osaka, Japan

    Keiichi Kawai

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  1. Yasuki Habu
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Habu, Y., Maeda, K., Kusuda, T. et al. “Proton-pump inhibitor-first” strategy versus “step-up” strategy for the acute treatment of reflux esophagitis: a cost-effectiveness analysis in Japan. J Gastroenterol 40, 1029–1035 (2005). https://doi.org/10.1007/s00535-005-1704-y

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  • DOI: https://doi.org/10.1007/s00535-005-1704-y

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