{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T07:20:11Z","timestamp":1769584811915,"version":"3.49.0"},"reference-count":47,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Topical corticosteroids, proton\u2010pump inhibitors (PPI) and elimination diets (ED) are equally recommended as first\u2010line therapies for pediatric eosinophilic esophagitis (EoE). Dupilumab (DUP) is usually used for refractoriness. We aim to assess the cost\u2010utility of all potential sequential treatments for EoE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A Markov model under the payer's perspective was used to describe induction, maintenance, and reinductions for nonresponders over 10 years. Dietary options included step\u2010up restriction starting from two foods, and from cow's milk (CM). Topical corticosteroids viscous solutions, or budesonide orodispersible tablets (BOT) were considered. Nonresponsiveness led to esophageal dilation. Simulation parameters were defined by systematic review. We deterministically selected the most cost\u2010effective permutation as reference. Incremental cost\u2010utility ratios (ICUR) of each alternative sequence were compared to a willingness\u2010to\u2010pay (WTP) threshold of \u20ac30,000. Sequences with the highest number of quality\u2010adjusted life\u2010years (QALY) and the highest QALY below WTP were probabilistically explored. Sensitivity analysis was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>PPI\u2010ED(CM)\u2010BOT\u2010DUP was the most cost\u2010effective sequence, resulting in \u20ac2373\/QALY and 7.20 QALY at the time horizon. DUP\u2010BOT\u2010PPI\u2010ED(CM) gave the uppermost QALY, 7.42, but any iteration was cost\u2010effective, yielding a median ICUR of \u20ac323,774\/QALY. PPI\u2010BOT\u2010ED(CM)\u2010DUP, however, had a higher chance of being under the WTP (83%), showed a median ICUR of \u20ac25,156\/QALY and provided 7.31 QALY. An 83% reduction of DUP price was needed to make DUP\u2010BOT\u2010PPI\u2010ED(CM) and PPI\u2010BOT\u2010ED(CM)\u2010DUP equally as efficient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>BOT and CM\u2010starting step\u2010up ED are present in both effective and cost\u2010effective sequential treatments for EoE. The option PPI\u2010BOT\u2010ED(CM)\u2010DUP succeeded in approaching the most effective alternative while balancing costs.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpn3.70106","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T05:24:31Z","timestamp":1749446671000},"page":"295-303","source":"Crossref","is-referenced-by-count":2,"title":["Cost\u2010utility analysis of sequential therapies for pediatric\u2010onset eosinophilic esophagitis"],"prefix":"10.1002","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1660-6993","authenticated-orcid":false,"given":"Jos\u00e9 Vicente","family":"Arcos\u2010Machancoses","sequence":"first","affiliation":[{"name":"Department of Paediatric Gastroenterology, Hepatology and Nutrition Hospital Cl\u00ednic Universitari Valencia Spain"},{"name":"INCLIVA Biomedical Research Institute Valencia Spain"},{"name":"Universitat de Val\u00e8ncia Valencia 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