Economic reflections on proton pump inhibitor therapy for non-erosive reflux disease

Proton pump inhibitor (PPI) therapy for gastroesophageal reflux disease is a good example of the evolution of economic analysis. Initial studies were simple models constructed on spreadsheets and described the most cost-effective therapy in terms of cost per cure of esophagitis. This tells a third-party payer what is the most efficient approach to healing esophagitis (technical efficiency) but does not give any indication of whether treating esophagitis is good value for money in the first place or whether health care dollars would be better spent in treating other diseases (allocative efficiency). As economic analyses became more sophisticated, more complex models were constructed. Outcomes were expressed in terms of cost per quality-adjusted life year gained or the question was framed in terms of the probability a strategy would be cost effective depending on willingness to pay for a month free from symptoms. These approaches answer the question of whether treating gastroesophageal reflux disease is good value for money. Models have traditionally evaluated treatment of esophagitis, but this does not address the most efficient therapy of non-erosive reflux disease. This article describes a simplified model (for illustrative purposes only) and suggests that PPI therapy is a cost-effective approach for the treatment of esophagitis whether generic or proprietary PPI costs are applied. PPI therapy is also likely to be a cost-effective strategy for non-erosive reflux disease at generic but not at proprietary prices.