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Cost-Effectiveness of Chemoprevention with Proton Pump Inhibitors in Barrett’s Esophagus

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Abstract

Background

Proton pump inhibitors (PPIs) may reduce the risk of esophageal adenocarcinoma (EAC) in patients with Barrett’s esophagus. PPIs are prescribed for virtually all patients with Barrett’s esophagus, irrespective of the presence of reflux symptoms, and represent a de facto chemopreventive agent in this population. However, long-term PPI use has been associated with several adverse effects, and the cost-effectiveness of chemoprevention with PPIs has not been evaluated.

Aim

The purpose of this study was to assess the cost-effectiveness of PPIs for the prevention of EAC in Barrett’s esophagus without reflux.

Methods

We designed a state-transition Markov microsimulation model of a hypothetical cohort of 50-year-old white men with Barrett’s esophagus. We modeled chemoprevention with PPIs or no chemoprevention, with endoscopic surveillance for all treatment arms. Outcome measures were life-years, quality-adjusted life years (QALYs), incident EAC cases and deaths, costs, and incremental cost-effectiveness ratios.

Results

Assuming 50 % reduction in EAC, chemoprevention with PPIs was a cost-effective strategy compared to no chemoprevention. In our model, administration of PPIs cost $23,000 per patient and resulted in a gain of 0.32 QALYs for an incremental cost-effectiveness ratio of $12,000/QALY. In sensitivity analyses, PPIs would be cost-effective at $50,000/QALY if they reduce EAC risk by at least 19 %.

Conclusions

Chemoprevention with PPIs in patients with Barrett’s esophagus without reflux is cost-effective if PPIs reduce EAC by a minimum of 19 %. The identification of subgroups of Barrett’s esophagus patients at increased risk for progression would lead to more cost-effective strategies for the prevention of esophageal adenocarcinoma.

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Acknowledgments

Dr. Sharaiha was supported by a training grant from the National Cancer Institute (T32 CA009529). Dr. Freedberg is supported in part by a training grant from the National Institute of Diabetes and Digestive and Kidney Diseases (T32 DK083256-04). Dr. Abrams was supported in part by a Career Development Award from the National Cancer Institute (K07 CA132892). This publication was also supported in part by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1 RR024156.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA

    Reem Z. Sharaiha

  2. Division of Digestive and Liver Diseases, Columbia University Medical Center, 630 West 168th Street, PH Building, 7th Floor, New York, NY, 10032, USA

    Daniel E. Freedberg & Julian A. Abrams

  3. Department of Health Policy and Management, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA

    Y. Claire Wang

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  1. Reem Z. Sharaiha
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Correspondence to Reem Z. Sharaiha.

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10620_2014_3186_MOESM1_ESM.tif

Supplemental Figure 1. Sensitivity analyses varying cost and risk reduction for chemoprevention with proton pump inhibitors, with no chemoprevention (surveillance only) compared to PPIs. The X-axis represents the  % EACs prevented by PPI therapy, and the Y-axis represents the cost ($/year) of PPIs. Figure 4A represents the analyses for WTP $50,000, whereas Figure 4B represents WTP $100,000. (TIFF 184 kb)

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Sharaiha, R.Z., Freedberg, D.E., Abrams, J.A. et al. Cost-Effectiveness of Chemoprevention with Proton Pump Inhibitors in Barrett’s Esophagus. Dig Dis Sci 59, 1222–1230 (2014). https://doi.org/10.1007/s10620-014-3186-3

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