Heartburn cost-effectiveness of therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]

The use of proton pump inhibitors for 8 weeks associated with lifestyle modifications is a cost-saving strategy in patients with heartburn and gastroesophageal reflux disease (GERD).

• A study from Stanford University School of Medicine revealed that “an 8-wk course of PPIs for initial symptom relief, followed by repeat courses of therapy initiated when symptoms recur, is more cost-effective than step-up or step-down strategies, or continuous therapy with either H2RAs or PPIs.”^[1]
• Costs estimated for the treatment of GERD according to the medication and regimen – considering mild GERD from 40yrs until death (in 1999 US dollars):
  • Lifestyle – $0
  • PPI-on-demand – $26,167
  • H2RA-PPI – $27,846
  • H2RA – $29,965
  • Step down – $37,641
  • PPI, continuous – $41,112
  • Laparoscopic Nissen fundoplication (includes 2-day hospital stay) – approximately – $11,064.87
• Considering that the complications Barrett’s esophagus may lead to esophageal cancer which presents with a much more costlier treatment, the on-demand PPI-therapy is the most cost-effective treatment available. The paper also stated that even thought it is the most cost-effective choice, it was the least used. The study was performed in 2000, which may cause its results to vary dramatically in more recent times.