OBJECTIVES:

To compare the efficacy, safety, and cost-effectiveness of standard-dose of different PPI drugs in the initial non-eradication treatment of DU.

METHODS:

We searched PubMed, Embase, Cochrane Library, Clinical Trial.gov, China National Knowledge Infrastructure, VIP database, and Wanfang database from their earliest records to September 2017. Randomized controlled trials (RCTs) evaluating omeprazole (20mg/day), pantoprazole (40mg/day), lansoprazole (30mg/day), rabeprazole (20mg/day), ilaprazole (10mg/day), ranitidine (300mg/day), famotidine (40mg/day), or placebo for DU were included. The outcomes were 4-week ulcer healing rate (4-UHR) and the incidence of adverse events (IAEs). A network meta-analysis (NMA, registration number: PROSPERO CRD 42017079704) using Bayesian random effects model was conducted, and a cost-effectiveness analysis using the decision tree model was performed from the perspective of the third-party payer over one year.

RESULTS: A total of 62 RCTs involving 10,339 participants (8 interventions) were included. The NMA showed that all the PPIs significantly increased the 4-UHR compared to H2 receptor antagonists (H2RA) and placebo, while there was no significant difference for 4-UHR among PPIs. As to IAEs, no significant difference was observed among PPIs, H2RA, and placebo during 4-week follow-up. Based on the costs of both PPIs and management of AEs in China, the incremental cost-effectiveness ratio per quality life year for pantoprazole, lansoprazole, rabeprazole, and ilaprazole relative to omeprazole corresponded to US$5134.67, US$17801.67, US$25488.31, and US$44572.22, respectively.

CONCLUSIONS:

Although the efficacy and tolerance of different PPI are similar in the initial non-eradication treatment of DU, pantoprazole (40mg/day) seems to be the most cost-effective choice in China.