Ofman J J, Yamashita B D, Siddique R M, Larson L R, Willian M K
Cedars-Sinai Department of Medicine and Health Services Research, Division of Gastroenterology, Los Angeles, CA, USA.
Am J Manag Care. 2000 Aug;6(8):905-16.
To compare the cost effectiveness of rabeprazole (RAB) and ranitidine (RAN) in acute and maintenance therapy for erosive esophagitis using symptom response, rather than endoscopic healing, as the clinical outcome.
Decision analysis was used to model the cost effectiveness of competing therapies based on the results of clinical trials of RAB versus RAN and estimates from the medical literature.
The model's base case scenario compared brand-name RAB (estimated average wholesale price) with generic RAN (25% of the average wholesale price of brand-name RAN). Medical costs for hospitalizations, procedures, and office visits reflected 1998 Medicare payments. The 1-year maintenance model accounted for drug-class switching and symptomatic, rather than endoscopic, recurrences. Effectiveness was reported as the percentage of patients in whom a symptomatic recurrence was prevented. The cost per symptomatic recurrence prevented was reported as an average and an incremental cost-effectiveness ratio.
The per-patient cost of RAB therapy was higher than that of RAN therapy ($2020 vs $1917); RAB therapy, however, was more effective than RAN therapy in preventing symptomatic recurrences (74% vs 41%). The average cost-effectiveness ratio was lower for RAB therapy than for RAN therapy ($2748 per symptomatic recurrence prevented vs $4719 per symptomatic recurrence prevented). The cost of preventing one additional symptomatic recurrence with RAB rather than RAN was $313 (incremental cost-effectiveness ratio). Sensitivity analysis conducted on key clinical and cost variables supported the robustness of the decision model.
This analysis demonstrates that management of esophagitis with RAB is more effective, and may be more cost effective, than management with generic RAN, despite RAB's higher per-unit cost.
以症状缓解而非内镜下愈合作为临床结局，比较雷贝拉唑（RAB）和雷尼替丁（RAN）在糜烂性食管炎急性治疗和维持治疗中的成本效益。
基于RAB与RAN的临床试验结果及医学文献估计值，采用决策分析对竞争性治疗的成本效益进行建模。
模型的基础病例情景将品牌RAB（估计平均批发价）与普通RAN（品牌RAN平均批发价的25%）进行比较。住院、诊疗程序和门诊的医疗费用反映了1998年医疗保险支付情况。1年维持模型考虑了药物类别转换以及症状性复发而非内镜下复发。有效性以预防症状性复发的患者百分比表示。预防每例症状性复发的成本以平均值和增量成本效益比报告。
RAB治疗的人均成本高于RAN治疗（2020美元对1917美元）；然而，RAB治疗在预防症状性复发方面比RAN治疗更有效（74%对41%）。RAB治疗的平均成本效益比低于RAN治疗（每预防一例症状性复发2748美元对4719美元）。用RAB而非RAN预防一例额外症状性复发的成本为313美元（增量成本效益比）。对关键临床和成本变量进行的敏感性分析支持了决策模型的稳健性。
该分析表明，尽管RAB的单位成本较高，但与普通RAN相比，用RAB治疗食管炎更有效，且可能更具成本效益。
