Evaluating the cost-effectiveness of replacing lansoprazole with vonoprazan for treating erosive oesophagitis.

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Saeash Jeyarajan, Thejasvin K, Sneha Pimpalnerkar, Emily Zichu Deng, Zain Ahmad, Diya Banerjee, Laure de Preux
{"title":"Evaluating the cost-effectiveness of replacing lansoprazole with vonoprazan for treating erosive oesophagitis.","authors":"Saeash Jeyarajan, Thejasvin K, Sneha Pimpalnerkar, Emily Zichu Deng, Zain Ahmad, Diya Banerjee, Laure de Preux","doi":"10.1136/bmjgast-2024-001709","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This cost-effectiveness analysis compares vonoprazan against lansoprazole, a gold-standard proton pump inhibitor, in managing erosive oesophagitis.</p><p><strong>Methods: </strong>The economic evaluation was carried out using data from a double-blind, randomised control trial. Costs were measured in pounds sterling. Effectiveness was assessed on a binary scale, resolution versus non-resolution of disease, after 32 weeks.</p><p><strong>Results: </strong>The primary analysis produced an incremental cost-effectiveness ratio (ICER) of £3421.27 per resolution. After applying quality-adjusted life year (QALY) data from the REFLUX trial (2008), we derived an ICER/QALY of £34 747.32, marginally exceeding the £30 000 threshold set by the National Institute for Health and Care Excellence. However, further subgroup analysis showed cost-effectiveness when healing severe grades of oesophagitis (ICER/QALY of £22 165.56). The first sensitivity analysis considers the typically non-invasive determination of disease resolution; the ICER/QALY of £15 826.98 supports vonoprazan's use in treating severe oesophagitis. The second considers a longer healing phase alongside a stronger 30 mg maintenance dose of lansoprazole, concordant with current guidelines; the ICER/QALY of £43 998.39 suggests the guidelines (regarding dosage, frequency and duration) must be optimised for vonoprazan. The final sensitivity analysis accounts for variations in quality-of-life measures, which grossly inflate the ICER/QALY (£118 216.32); this emphasises that vonoprazan should mainly be considered for patients with persistent symptoms and high severity.</p><p><strong>Conclusion: </strong>Vonoprazan is potentially cost-effective for the initial healing of severe oesophagitis, after endoscopic diagnosis. Further trials and economic evaluations are necessary for the symptom-based prescription of vonoprazan and to determine the optimal dosage, frequency and duration.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083356/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/bmjgast-2024-001709","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: This cost-effectiveness analysis compares vonoprazan against lansoprazole, a gold-standard proton pump inhibitor, in managing erosive oesophagitis.

Methods: The economic evaluation was carried out using data from a double-blind, randomised control trial. Costs were measured in pounds sterling. Effectiveness was assessed on a binary scale, resolution versus non-resolution of disease, after 32 weeks.

Results: The primary analysis produced an incremental cost-effectiveness ratio (ICER) of £3421.27 per resolution. After applying quality-adjusted life year (QALY) data from the REFLUX trial (2008), we derived an ICER/QALY of £34 747.32, marginally exceeding the £30 000 threshold set by the National Institute for Health and Care Excellence. However, further subgroup analysis showed cost-effectiveness when healing severe grades of oesophagitis (ICER/QALY of £22 165.56). The first sensitivity analysis considers the typically non-invasive determination of disease resolution; the ICER/QALY of £15 826.98 supports vonoprazan's use in treating severe oesophagitis. The second considers a longer healing phase alongside a stronger 30 mg maintenance dose of lansoprazole, concordant with current guidelines; the ICER/QALY of £43 998.39 suggests the guidelines (regarding dosage, frequency and duration) must be optimised for vonoprazan. The final sensitivity analysis accounts for variations in quality-of-life measures, which grossly inflate the ICER/QALY (£118 216.32); this emphasises that vonoprazan should mainly be considered for patients with persistent symptoms and high severity.

Conclusion: Vonoprazan is potentially cost-effective for the initial healing of severe oesophagitis, after endoscopic diagnosis. Further trials and economic evaluations are necessary for the symptom-based prescription of vonoprazan and to determine the optimal dosage, frequency and duration.

评价用vonoprazan替代兰索拉唑治疗糜烂性食管炎的成本-效果。
目的:本成本-效果分析比较了vonoprazan和兰索拉唑(一种金标准质子泵抑制剂)治疗糜烂性食管炎的效果。方法:采用双盲、随机对照试验数据进行经济评价。费用是以英镑计算的。32周后,用二值量表(疾病缓解与疾病未缓解)评估有效性。结果:初步分析产生了每个分辨率3421.27英镑的增量成本-效果比(ICER)。应用反流试验(2008年)的质量调整生命年(QALY)数据后,我们得出ICER/QALY为34 747.32英镑,略微超过国家健康与护理卓越研究所设定的3万英镑阈值。然而,进一步的亚组分析显示,治疗重度食管炎的成本效益(ICER/QALY为22 165.56英镑)。第一个敏感性分析考虑了典型的疾病消退的非侵入性测定;ICER/QALY为15826.98英镑,支持使用vonoprazan治疗严重食管炎。第二种方案考虑更长的愈合期,同时使用更强的30mg兰索拉唑维持剂量,与目前的指南一致;ICER/QALY为43998.39英镑,表明必须优化vonoprazan的指南(关于剂量、频率和持续时间)。最终的敏感性分析考虑了生活质量指标的变化,这些指标严重夸大了ICER/QALY(118 216.32英镑);这强调了vonoprazan应主要用于症状持续和严重程度高的患者。结论:Vonoprazan对于内镜诊断后的严重食管炎具有潜在的成本效益。进一步的试验和经济评价是必要的,以症状为基础的处方,并确定最佳剂量,频率和持续时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信