Economic Model Supports PCABs as Cost-Saving Option for GERD Management

A decision-analytic model evaluating gastroesophageal reflux disease (GERD) therapies suggests that potassium-competitive acid blockers (PCABs), such as vonoprazan, may offer substantial cost savings for both patients and insurers while improving symptom control.

The study compared vonoprazan 20 mg daily, commonly used proton pump inhibitors (PPIs), and no treatment over a 1-year time frame. Clinical response data were based on heartburn-free days from a recent phase 3 trial, while health care utilization for ongoing reflux symptoms was derived from national observational studies.

The analysis found that inadequate treatment of GERD symptoms costs patients an average of $4443 annually and insurers $3784. 

When modeled as a covered option, PCABs could save over $3000 annually in combined patient and insurer costs, while improving quality-adjusted life years (QALYs) by 0.06 per patient per year. The model determined that PCABs would remain cost-saving at prices up to $8.57 per pill after applying typical pharmacy benefit manager rebates and discounts, assuming comparable efficacy to PPIs in future regulatory trials.

The authors noted, “We demonstrate that aiming GERD-related drug development toward heartburn relief appears critical to align cost-effective incentives for industry and insurers with those of patients and gastroenterologists.”

These findings suggest that the value proposition of PCABs extends beyond clinical benefit and could influence payer coverage decisions. Aligning future drug development with measurable symptom relief may strengthen the case for broad insurance adoption and support more effective GERD management strategies across care settings.

Reference 
Shah ED, Curley MA, Patel A, Lo W, Chan WW. Heartburn relief Is the major unmet need for drug development in gastroesophageal reflux disease: threshold value analysis. Clin Gastroenterol Hepatol. 2025;23(2):263-271. doi:10.1016/j.cgh.2024.01.049