GORD (gastroesophageal reflux disease) is a condition in which the stomach contents leak into the oesophagus, causing heartburn and acid regurgitation. The standard treatment is medication that inhibits the production of stomach acid, known as proton pump inhibitors (PPIs). As they are very effective and safe, in some cases they are also administered regularly to people with GORD without damage to the mucosa. This report compares taking proton pump inhibitors (PPIs) on a continuous basis and taking them on demand. It examines the efficacy, safety, cost effectiveness and budgetary impact, as well as legal, social, organisational and ethical aspects if only a certain number of PPI tablets are reimbursed per year.
The report examined various studies as part of a literature review covering the period from 2000 to 2019. Comparison of continuous long-term therapy with on-demand therapy showed that satisfaction and quality of life were high and that there were only very minimal, insignificant differences. However, the study data were not entirely comparable and did not allow any definitive conclusions to be drawn as to whether continuous or on-demand treatment is preferable. The data on efficacy show that taking PPIs on demand led to a smaller number of tablets taken per day. When the PPIs are taken on a continuous basis, they are more effective at alleviating heartburn, which could be due to the fact that the tablets are taken regularly, in other words also when the person is not experiencing symptoms.
The report concludes that reducing the cost reimbursement for PPI treatments would not cause any legal, social, ethical or organisational issues or limitations. The cost-benefit calculation revealed that on-demand therapy is more cost-effective than continuous therapy in various scenarios, whether without restriction or if reducing to 100, 200 or 365 tablets a year. As for the budgetary impact, switching to on-demand use of PPIs over five years could result in cost savings of between CHF 50 million and CHF 127 million. Introducing a restriction to reimbursement would therefore allow significant savings in treatment costs, depending on how many tablets the health insurance reimburses per year.
