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

## TL;DR

Switching patients from long-term proton pump inhibitors to episodic alginate treatment can save the NHS millions in costs and reduce adverse effects.

## Contribution

This study introduces a budget impact model showing cost savings from transitioning patients to episodic alginate therapy.

## Key findings

- Transitioning 20% of patients to alginate saved £11.5 million in drug costs over five years.
- Including adverse effects increased savings to £16.6 million due to fewer side effects.
- Results were robust under sensitivity analysis.

## Abstract

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.

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.

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.

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.

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.