A pharmacoeconomic comparison of the efficacy and costs of pantoprazole and omeprazole for the treatment of peptic ulcer or gastroesophageal reflux disease in the Netherlands

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The focus of treatment of patients with peptic ulcer or gastroesophageal reflux disease has changed during the last 15 years, with a shift from histamine2-receptor antagonists to proton-pump inhibitors (PPIs). From 1993 to 2000, expenditures for omeprazole (90% of total market share of PPIs) increased in the Netherlands from €68 million to €230 million. In 1999, expenditures for pantoprazole accounted for the majority of the rest of the market share for PPIs.The objective of this study was to compare the efficacy and costs of treatment with pantoprazole and omeprazole in the Netherlands.First, we reviewed clinical studies that compared the efficacy of different dosages of omeprazole and pantoprazole. Second, we analyzed data from a nationwide database of drug prescriptions to determine the dosages used in daily practice in 1999. The data were based on a representative sample of ∼40% of the Dutch community pharmacies. Third, we modeled the outcome of potential substitution of pantoprazole for omeprazole and the corresponding scenarios for nationwide cost savings using the prescription information from the nationwide database. Potential savings within the Dutch health care system were estimated.The 1999 prescription data indicated that pantoprazole treatment cost a mean €1.59/d, compared with €2.12/d for omeprazole (€1.00 = US $1.0487). The mean cost per defined daily dose of omeprazole was €1.65, compared with €1.59 for pantoprazole. Following the summary of product characteristics, treatment with pantoprazole appeared to be less costly for all indications. The projected annual cost savings for substituting pantoprazole for omeprazole on 90% of treatment days were estimated at €40.8 million. However, these projected savings may be offset by the costs of switching and the costs of upward dose adjustments that some patients may require.Based on the available documentation about effectiveness and costs of omeprazole and pantoprazole, pantoprazole may provide a more favorable pharmacoeconomic profile than omeprazole. However, this is only true if the substitution of omeprazole by pantoprazole can be achieved without loss of efficacy of tolerability.