Cost-effectiveness analysis of novel endoscopic procedures and vonoprazan for PPI-refractory GERD

Background: The guideline recommends the administration of vonoprazan for gastroesophageal reflux disease (GERD) refractory to PPI therapy; however, there are concerns regarding the safety of long-term P-cab use. Endoscopic anti-reflux treatment is expected to be an alternative to long-term P-cab therapy. This study aimed to compare the cost-effectiveness of both treatments.
Methods: A Markov simulation model that tracks changes in symptoms and P-cab requirements after treatment for PPI-refractory GERD was developed. This model employed two strategies: endoscopic treatment strategies with endoscopic anti-reflux surgery (ARMS and ESD-G) and medical treatment strategy with vonoprazan. Both strategies included outpatient follow-up every 2 months, with low and high vonoprazan doses adjusted according to the degree of symptoms. The incremental cost-effectiveness ratio (ICER) of the two strategies was compared according to the follow-up period; a strategy was defined as superior cost-effectiveness if the ICER was less than 5 million.
Results: In terms of ICER, the medical treatment strategy was more cost-effective, with up to 40 years of follow-up after treatment. The endoscopic treatment strategy was more cost-effective only after 50 years of follow-up. A sensitivity analysis showed that to maintain the cost-effectiveness of the endoscopic treatment strategy, the successful endoscopic treatment rate should be over 72.5%.
Conclusions: The cost-effectiveness of the endoscopic treatment strategy was favorable for long-term follow-up. Future improvements in treatment techniques may improve cost-effectiveness with shorter follow-up.