Kivioja Akseli, Linnosmaa Ismo, Vehviläinen Arto, Vohlonen Ilkka
Department of Social Pharmacy, Center for Pharmaceutical Policy and Economics, University of Kuopio, P.O. Box 1627, FIN-70211, Kuopio, Finland.
Eur J Pharm Sci. 2004 Feb;21(2-3):171-8. doi: 10.1016/j.ejps.2003.10.004.
Gastroesophageal reflux disease (GERD), is a common disorder. The most effective medical treatment for GERD is a proton pump inhibitor (PPI). The aim of this study was to specify the most inexpensive PPI therapy for GERD, and to examine the implications of varying outcome measure, holding time, on the conclusions about the cost-effectiveness of the treatments. Proton pump inhibitors that have holding time of intragastric pH>4 for at least 11h in 24h period (esomeprazole, lansoprazole, omeprazole and rabeprazole), were included. In this cost-minimization analysis (CMA), data on holding times were gathered from scientific publications listed in MEDLINE, prices of proton pump inhibitors from the Finnish database of drug prices and the treatment dosages were taken from the official guide of drug therapies in Finland. A decision tree was applied and the probabilities utilized were acquired from three expert physicians. The cost-minimization analysis was performed in three settings. At first, drugs that had a holding time (pH>4) of 11h or more were included. Secondly, drugs that had a holding time of 12h or more were included, and thirdly, a holding time of 13h or more was required. In the first analysis, the least expensive PPI treatment was lansoprazole (average cost of 138.89 per patient). In the second analysis, least expensive treatment was rabeprazole (193.81 per patient), and in the third, rabeprazole again (193.81 per patient). Esomeprazole and omeprazole were not among two of the least expensive alternatives in any of the settings. Which proton pump therapy turns out to be the least expensive for GERD, depends on the length of the holding time desired. Varying the holding time of the drug had a profound effect on the conclusions about the cost-effectiveness of the alternative treatments.
胃食管反流病（GERD）是一种常见疾病。治疗GERD最有效的药物是质子泵抑制剂（PPI）。本研究的目的是确定治疗GERD最便宜的PPI疗法，并研究不同的结局指标、维持时间对治疗成本效益结论的影响。纳入了在24小时内胃内pH值>4的维持时间至少为11小时的质子泵抑制剂（埃索美拉唑、兰索拉唑、奥美拉唑和雷贝拉唑）。在这项成本最小化分析（CMA）中，维持时间的数据来自MEDLINE列出的科学出版物，质子泵抑制剂的价格来自芬兰药品价格数据库，治疗剂量取自芬兰药物治疗官方指南。应用了决策树，所使用的概率来自三位专家医生。成本最小化分析在三种情况下进行。首先，纳入维持时间（pH>4）为11小时或更长的药物。其次，纳入维持时间为12小时或更长的药物，第三，要求维持时间为13小时或更长。在第一次分析中，最便宜的PPI治疗是兰索拉唑（每位患者平均成本为138.89）。在第二次分析中，最便宜的治疗是雷贝拉唑（每位患者193.81），第三次分析中，还是雷贝拉唑（每位患者193.81）。在任何一种情况下，埃索美拉唑和奥美拉唑都不是最便宜的两种选择之一。哪种质子泵疗法对GERD来说最便宜，取决于所需的维持时间长度。改变药物的维持时间对替代治疗成本效益的结论有深远影响。
