Prevention of recurrences of erosive reflux esophagitis: a cost-effectiveness analysis of maintenance proton pump inhibition

Am J Med. 1997 Jan;102(1):78-88. doi: 10.1016/s0002-9343(96)00301-4.


Purpose: To determine the cost-effectiveness of three management strategies for healed erosive reflux esophagitis: maintenance therapy with a proton pump inhibitor (PPI) from the outset; no maintenance therapy unless a patient's symptoms recur once over a year; and no maintenance therapy unless a patient's symptoms recur twice over a year.

Materials and methods: Decision analysis using data from randomized trials of lansoprazole, case series, and expert opinion.

Results: For patients with grade 4 esophagitis, maintenance from the outset is the most efficient approach. For all other patients, providing maintenance PPI after a patient experiences two recurrences is the least costly but least effective approach. The other two approaches prevent more recurrences: waiting to initiate maintenance therapy until symptoms recur once requires an additional $73 for each recurrence prevented whereas maintenance PPI from the outset requires an additional $819 for each recurrence prevented. Maintenance therapy from the outset is cost effective if symptoms of esophagitis cause a 22% or greater decrement in quality of life (using $50,000 per quality-adjusted life year gained as a cost-effectiveness definition). However, withholding maintenance until the time of a first recurrence is cost effective if symptoms cause a 2% or greater decrement in quality of life.

Conclusion: For grades 2 and 3 esophagitis, providing maintenance therapy after a patient experiences a further recurrence is a preferred option that appears cost-effective across a wide array of assumptions. Maintenance therapy from the outset, however, appears cost-effective only for those patients who report a significant decline in quality of life associated with esophagitis or for those patients with baseline grade 4 esophagitis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Anti-Ulcer Agents / economics*
  • Anti-Ulcer Agents / therapeutic use
  • Cost-Benefit Analysis
  • Esophagitis, Peptic / economics*
  • Esophagitis, Peptic / prevention & control*
  • Humans
  • Lansoprazole
  • Omeprazole / analogs & derivatives*
  • Omeprazole / economics
  • Omeprazole / therapeutic use
  • Proton Pump Inhibitors*
  • Quality of Life*
  • Recurrence
  • Sensitivity and Specificity
  • Severity of Illness Index


  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Anti-Ulcer Agents
  • Proton Pump Inhibitors
  • Lansoprazole
  • Omeprazole