Budget Impact Analysis of Stepping Down Patients from Long-Term Inappropriate Proton Pump Inhibitor Use to Episodic Alginate Treatment: NHS England Perspective.

Background: Long-term inappropriate use of proton pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease (GERD) and dyspepsia is a common issue that can lead to unnecessary healthcare costs and potential adverse effects. Alternative treatments, such as episodic alginate therapy, may offer a more cost-effective and clinically appropriate approach. Objective: To investigate the financial impact of transitioning patients from long-term inappropriate PPI use to episodic alginate treatment for GERD and dyspepsia, from the perspective of the National Health Service (NHS) England. Methods: A budget impact model was used to compare costs over a 5-year period for adult patients using long-term inappropriate PPIs, with and without alginate treatment. By the fifth year, 20% of patients were assumed to have switched to alginate treatment. In this model, the base case analysis included only drug costs, while a scenario analysis also considered adverse effect costs. Results: Over the 5-year period, net savings of £11.5 million were observed in drug acquisition costs when 20% of patients (4.8 million) successfully transitioned to alginate treatment. When adverse effect costs were included in the scenario analysis, net savings increased to £16.6 million due to a slight reduction in the number of adverse effects. One-way sensitivity analysis confirmed the robustness of these results. Conclusions: Transitioning patients from long-term PPI use to episodic alginate treatment is beneficial for patients, potentially reducing adverse effects, and can lead to significant budgetary cost savings, which can be reallocated.