Cost effectiveness of omeprazole and ranitidine in intermittent treatment of symptomatic gastro-oesophageal reflux disease

Objective: This 1-year study compared the cost effectiveness of omeprazole and ranitidine when used as initial therapy in an intermittent treatment strategy for the management of patients with symptomatic gastro-oesophageal reflux disease with or without erosive oesophagitis. Design and setting: A prospective health economic analysis was conducted alongside an international multicentre randomised, double-blind clinical study. The economic analysis was performed from a societal perspective. Patients: A total of 704 patients in the UK, the Republic of Ireland, Germany, France, Italy and Spain were randomised to 1 of the 3 treatment groups. Interventions: Patients were randomised to receive either omeprazole 20mg once daily, omeprazole 10mg once daily or ranitidine 150mg twice daily. Initial treatment failure resulted in dose titration and drug switching from ranitidine to omeprazole, and subsequently open maintenance treatment. Main outcome measures and results: The estimated mean direct medical costs (medication and number of visits and endoscopies) were found to be lower for both dosages of omeprazole than for ranitidine in all countries except Germany. However. none of the differences were statistically significant. The differences between omeprazole 10mg and omeprazole 20mg were small and nonsignificant. With regard to numbers of symptom-free days, both omeprazole 20mg and omeprazole 10mg were found to be more effective than ranitidine. However, none of the differences were statistically significant. Conclusions: Following a pragmatic interpretation, incorporating intermediate short term results, the results in this study give no support to the notion that a step-up approach, either as dose titration from omeprazole 10mg to omeprazole 20mg or as drug switching from ranitidine to omeprazole, will result in cost savings and thereby be cost effective.