OBJECTIVES: To assess the cost-effectiveness of two treatment strategies for reflux esophagitis (RE) in Finland: acute treatment with esomeprazole 40mg qd followed by maintenance treatment with 20mg qd, or acute treatment with pantoprazole 40mg qd followed by maintenance treatment with 20mg qd. METHODS: A decision analysis model was developed to compare the two treatment strategies with regard to direct medical costs (drugs, physician visits, investigations, procedures) and productivity costs (absence from work and reduced productivity while at work) using a 7-month time horizon. Probabilities for treatment success were based on results from a large multinational, randomised, double-blind clinical study of up to 8 weeks acute (n=3,170) and 6 months maintenance (n=2,766) treatment of RE. The proportion of patients with treatment success and an estimated number of weeks with symptoms of gastro-esophageal reflux disease (GERD) were used as effectiveness measures. Sensitivity analyses were made by using upper and lower 95% confidence limits of the clinical study results, as well as by changing patient management assumptions. RESULTS: The proportion of patients with treatment success, defined as healed RE within 8 weeks acute treatment and no relapse during subsequent maintenance treatment, was 83.4% and 69.6% for esomeprazole and pantoprazole, respectively (i.e. an absolute difference of 13.8%). This corresponded to 1.1 weeks less with GERD per patient by using esomeprazole. In the base case analysis, the mean estimated direct medical cost per patient was slightly lower for the esomeprazole strategy (EUR 33) and the estimated productivity loss per patient was considerably lower for the esomeprazole strategy (EUR 114). Sensitivity analyses supported robustness of main findings. CONCLUSION: The esomeprazole treatment strategy was found to be cost-effective compared with the pantoprazole treatment strategy, since esomeprazole provides better effectiveness and savings in work productivity costs at similar or lower direct medical costs.