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

Habu, Yasuki; Maeda, Kazuo; Kusuda, Takeo; Yoshino, Tatsuhiko; Shio, Seiji; Yamazaki, Maki; Hayakumo, Takanobu; Hayashi, Kyohei; Watanabe, Yoshiyuki; Kawai, Keiichi

doi:10.1007/s00535-005-1704-y

Cited by 29 publications

(26 citation statements)

References 23 publications

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“…PPIs are more cost-effective for the J Gastroenterol (2016) 51:751-767 757 treatment of GERD than H2RAs or step-up therapy starting from H2RA [72,73]. PPIs have a superior effect in terms of heartburn symptom relief over H2RAs or alginate for the treatment of GERD diagnosed by symptoms [66,74].…”

Section: Cq: Is An Acid Suppressant Effective For the Treatment Of Gerd?mentioning

confidence: 99%

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

et al. 2016

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As an increase in gastroesophageal reflux disease (GERD) has been reported in Japan, and public interest in GERD has been increasing, the Japanese Society of Gastroenterology published the Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009. Six years have passed since its publication, and there have been a large number of reports in Japan concerning the epidemiology, pathophysiology, treatment, and Barrett's esophagus during this period. By incorporating the contents of these reports, the guidelines were completely revised, and a new edition was published in October 2015. The revised edition consists of eight items: epidemiology, pathophysiology, diagnosis, internal treatment, surgical treatment, esophagitis after surgery of the upper gastrointestinal tract, extraesophageal symptoms, and Barrett's esophagus. This paper summarizes these guidelines, particularly the parts related to the treatment for GERD. In the present revision, aggressive proton pump inhibitor (PPI) maintenance therapy is recommended for severe erosive GERD, and on-demand therapy or continuous maintenance therapy is recommended for mild erosive GERD or PPI-responsive non-erosive GERD. Moreover, PPI-resistant GERD (insufficient symptomatic improvement and/or esophageal mucosal break persisting despite the administration of PPI at a standard dose for 8 weeks) is defined, and a standard-dose PPI twice a day, change in PPI, change in the PPI timing of dosing, addition of a prokinetic drug, addition of rikkunshito (traditional Japanese herbal medicine), and addition of histamine H2-receptor antagonist are recommended for its treatment. If no improvement is observed even after these treatments, pathophysiological evaluation with esophageal impedancepH monitoring or esophageal manometry at an expert facility for diseases of the esophagus is recommended.

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Section: Cq: Is An Acid Suppressant Effective For the Treatment Of Gerd?mentioning

confidence: 99%

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

et al. 2016

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“…Acute therapeutic strategies may vary according to the initial therapeutic approach, which is defined as step-up , step-down or step-in. The step-up approach consists of an initial therapy starting with compounds less effective in controlling pH (antacids, alginates or H 2 -RAs), and switching to the use of PPIs when necessary, whereas the step-down approach consists of an initial use of PPIs with a subsequent reduction of their dosage [34,35,36]. These are pharmacoeconomic models that have been critically evaluated only in a limited number of studies, although the step-up approach is now considered the less cost-effective model for treating GERD and the clinically less appropriate [35].…”

Section: Optimizing Therapy Of Gerdmentioning

confidence: 99%

“…The step-up approach consists of an initial therapy starting with compounds less effective in controlling pH (antacids, alginates or H 2 -RAs), and switching to the use of PPIs when necessary, whereas the step-down approach consists of an initial use of PPIs with a subsequent reduction of their dosage [34,35,36]. These are pharmacoeconomic models that have been critically evaluated only in a limited number of studies, although the step-up approach is now considered the less cost-effective model for treating GERD and the clinically less appropriate [35]. In the clinical setting, it has been observed that the step-in approach (a therapeutic model that starts with and maintains a given dose of a PPI throughout the acute treatment of GERD) is the most effective approach in relieving symptoms and promoting healing of erosions, and also the economically most advantageous therapeutic model for GERD [37].…”

Section: Optimizing Therapy Of Gerdmentioning

confidence: 99%

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

et al. 2007

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Proton pump inhibitors (PPIs) are antisecretory agents that are widely used in the short- and long-term management of gastroesophageal reflux disease (GERD) to relieve symptoms, heal esophagitis, and prevent complications, such as strictures and Barrett’s esophagus. The total healthcare costs of GERD are high, especially for maintenance treatment. Therefore, the choice of cost-effective therapeutic options is an ineluctable challenge for public health authorities, third-party payers, and patients. In some European Union countries, a recent trend of public health authorities is to promote the choice of less expensive PPIs, regardless of their antisecretory potency – this in spite of the evidence that newer PPIs provide superior symptom relief and esophageal erosion healing compared to earlier drugs. Several large clinical trials have demonstrated the superiority of esomeprazole over other PPIs at standard doses for both initial and continuous maintenance therapy in patients with moderate/severe erosive esophagitis. The non-erosive GERD poses a major challenge as this condition appears more frequently to be less responsive to PPIs. The use of PPIs with the strongest antisecretory properties might reveal to be more adequate and cost-effective, particularly for this indication.

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“…Step-up" therapy for GERD has not been shown to be more eff ective than "step-down" therapy ( 11,12 ). However, for practitioners working in an health maintenance organization, increasing the restrictiveness of a formulary has been shown to reduce the likelihood of prescribing restricted medicines and increase the likelihood of practitioners prescribing formulary medicines (13)(14)(15)(16).…”

Section: The Red Sectionmentioning

confidence: 99%

How Do US Gastroenterologists Use Over-the-Counter and Prescription Medications in Patients With Gastroesophageal Reflux and Chronic Constipation?

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et al. 2015

American Journal of Gastroenterology

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Among US gastroenterologists, OTC medications now dominate primary therapy of GERD and CC. Despite feeling that name brand and store brand PPIs and laxatives are equally effective, the majority of gastroenterologists recommend brand name medicines and underestimate the cost savings associated with store brands. In this age of accountable care, greater efforts to help physicians and patients to better utilize their health-care dollars is warranted.

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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

Abstract: 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.

Cited by 29 publications

References 23 publications

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

How Do US Gastroenterologists Use Over-the-Counter and Prescription Medications in Patients With Gastroesophageal Reflux and Chronic Constipation?

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