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

J Gastroenterol. 2019 Dec;54(12):1083-1095. doi: 10.1007/s00535-019-01609-2. Epub 2019 Aug 8.


Background: 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.

Methods: 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.

Results: 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.

Conclusions: Vonoprazan-first strategy increased QALYs and appeared to be cost-effective for GERD patients compared with the esomeprazole- or rabeprazole-first strategies.

Keywords: Cost-utility analysis; Gastroesophageal reflux disease; Proton-pump inhibitor; Vonoprazan.

Publication types

  • Comparative Study

MeSH terms

  • Computer Simulation
  • Cost-Benefit Analysis
  • Esomeprazole / administration & dosage*
  • Esomeprazole / economics
  • Gastroesophageal Reflux / drug therapy*
  • Gastroesophageal Reflux / economics
  • Humans
  • Japan
  • Markov Chains
  • Proton Pump Inhibitors / administration & dosage
  • Proton Pump Inhibitors / economics
  • Pyrroles / administration & dosage*
  • Pyrroles / economics
  • Quality-Adjusted Life Years
  • Rabeprazole / administration & dosage*
  • Rabeprazole / economics
  • Recurrence
  • Sulfonamides / administration & dosage*
  • Sulfonamides / economics
  • Time Factors
  • Treatment Outcome


  • 1-(5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl)-N-methylmethanamine
  • Proton Pump Inhibitors
  • Pyrroles
  • Sulfonamides
  • Rabeprazole
  • Esomeprazole