Beyond the Induction Phase: Should We Keep the Proton Pump Inhibitor in Pediatric Eosinophilic Esophagitis?

Abstract

Background: Proton pump inhibitors (PPIs) are a common and effective management strategy for eosinophilic esophagitis (EoE) leading to successful remission in most cases. However, there is uncertainty regarding the ideal follow-up pharmacological treatment to maintain remission. We performed a cost-effectiveness and quality-adjusted life year (QALY) analysis.

Objectives: To compare various approaches of pharmacologic treatments for EoE.

Methods: A Markov model was constructed to evaluate the cost-effectiveness and QALY of maintenance therapies for eosinophilic esophagitis, including PPI, topical corticosteroids (tCS), and no treatment strategy, with crossover in treatments for primary and secondary nonresponse. The primary outcomes were incremental cost-effectiveness and QALY at a 5-year time horizon.

Results: In the base-case scenario (5-year time horizon), the average costs were no treatment:₪ 73,075, PPI:₪ 81,455, and tCS:₪ 145,669 as maintenance therapy, with PPI being the dominant strategy (more effective/less costly), and a QALY of 45543, 4.5538, and 4.2283, respectively.

Conclusions: PPI was the most effective/least costly maintenance therapy. PPI is also the most cost-effective pharmacologic strategy. The relatively low adverse effects of this treatment, in addition to its effectiveness and low cost, make it an ideal choice following successful PPI induction treatment.