Healthcare costs of GERD and acid-related conditions in pediatric patients, with comparison between histamine-2 receptor antagonists and proton pump inhibitors

Abstract

Background:

Gastroesophageal reflux disease and acid-related conditions (GERD/ARC) are common in pediatric practice but their costs have not been well characterized.

Aim:

To compare healthcare costs (HCC) and healthcare utilization (HCU) of pediatric GERD/ARC between groups of GERD/ARC patients initiated on histamine-2 receptor antagonists (H₂RAs) or proton pump inhibitors (PPIs) and matched controls.

Patients and methods:

Children (age < 18 years) diagnosed with GERD or ARC (exploratory category) were identified from a large US claims database (1999–2005) using ICD-9 codes. Costs of pediatric GERD/ARC were estimated by comparing 6-month post-diagnosis HCC between cases and matched controls. GERD/ARC-related HCC and HCU for the year 2005 were further compared between GERD/ARC patients initiated with PPIs vs. H₂RAs in terms of the cost differences relative to pre-initiation (difference-in-difference) and using multivariate regression to adjust for demographics, pre-treatment health status and pre-treatment costs.

Results:

A total of 27 865 matched pairs were identified. GERD/ARC patients incurred on average more 6-month total HCC than controls ($2386). In 2005, 1010 pediatric patients were initiated on H₂RAs or PPIs. About 61% were initiated on PPIs and incurred 1.8 times higher 6-month post-initiation GERD/ARC-related HCC than H₂RA-initiated patients ($661 vs. $372, p < 0.001). Although total 6-month GERD/ARC-related HCC increased for both PPI- and H₂RA-treated patients, the increase was 30% less for PPI-treated patients ($173 vs. $246, p = 0.521) in the difference-in-difference analysis and 69% less in the multivariate analysis ($109 vs. $347, p = 0.040).

Limitations:

The use of an exploratory definition for GERD/ARC, administrative claims data and potential coding errors in diagnosis codes used in selection process may limit the generalizability of the results.

Conclusion:

Pediatric GERD/ARC patients incurred significantly higher healthcare costs compared to similar children without GERD/ARC. Compared to patients initiated with H₂RAs, patients initiated with PPIs had more baseline comorbidities, and lower GERD/ARC-related HCC after beginning treatment.

Key words: :

• Acid-related conditions
• Claims database
• Gastroesophageal reflux disease
• Healthcare costs
• Histamine-2 receptor antagonists
• Proton pump inhibitors

Transparency

Declaration of funding

This research was sponsored by Takeda Pharmaceuticals North America, Inc.

Declaration of financial/other relationships

N.B., E.Q.W. and J.M. have disclosed that they are employees of Analysis Group, which received funding for the paper from Takeda; they also have received consulting fees from Takeda. O.D. has disclosed that he is an employee of Takeda and a former employee of TAP Pharmaceuticals (now Takeda). S.K. has disclosed that she was an employee of TAP at the time of this research and is currently employed by Astellas Pharma US Inc. S.P.N. has disclosed that she has served as a consultant and on the speakers’ bureau of Tadeda.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgment

The authors have disclosed that they had no outside editorial assistance in preparing this manuscript.