{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T05:02:34Z","timestamp":1784091754252,"version":"3.55.0"},"reference-count":48,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T00:00:00Z","timestamp":1735516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T00:00:00Z","timestamp":1735516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Digestion"],"abstract":"<jats:p>Introduction: Potassium-competitive acid blockers are effective against proton pump inhibitor-refractory gastroesophageal reflux disease; however, their long-term use is associated with economic disadvantages. Endoscopic procedures may reduce potassium-competitive acid blocker use. This study aimed to determine the optimal treatment strategy for patients with proton pump inhibitor-refractory gastroesophageal reflux disease from a cost-effectiveness perspective. Methods: Using a Markov state transition model to simulate symptom changes in patients with proton pump inhibitor-refractory gastroesophageal reflux disease, the cost-effectiveness of two strategies was compared: endoscopic treatment (anti-reflux mucosectomy or endoscopic submucosal dissection for gastroesophageal reflux disease) followed by potassium-competitive acid blocker versus medication with high-dose potassium-competitive acid blocker. In both strategies, potassium-competitive acid blocker maintained symptoms at the lowest controllable dose. The time horizon varied from 10 to 50 years. The quality-adjusted life year and incremental cost-effectiveness ratio were calculated. Willingness to pay was set at 5,000,000 Japanese yen. Results: The quality-adjusted life years gained were 0.90 and 0.95 for the endoscopic treatment and medication strategies, respectively. The incremental cost-effectiveness ratio varied with the follow-up period after the initial treatment, with the endoscopic treatment strategy being more cost-effective than the medication strategy at \u226550 years of follow-up. A dose reduction success rate of &lt;84.1% for high-dose potassium-competitive acid blocker and an endoscopic treatment success rate of &gt;66.8% were required to determine the superiority of the endoscopic treatment strategy at the 50-year follow-up after treatment. Conclusions: The endoscopic treatment strategy is not cost-effective unless the patient is followed up for &gt;50 years after the initial treatment. <\/jats:p>","DOI":"10.1159\/000543365","type":"journal-article","created":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T12:00:23Z","timestamp":1735560023000},"page":"277-286","source":"Crossref","is-referenced-by-count":1,"title":["Cost-Effectiveness Analysis of Endoscopic Treatment versus Medication Strategy for Proton Pump Inhibitor-Refractory Gastroesophageal Reflux 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