Heartburn in consumer-directed health care and the cost outcomes of therapeutic maximum allowable cost.

In 2005, the Agency for Healthcare Research and Quality (AHRQ) launched its comparative effectiveness initiative with the goal of providing information to consumers and health care providers to assist in making more informed choices among treatment alternatives.1 AHRQ evaluated the treatments for heartburn (gastroesophageal reflux disease [GERD]) in producing its first report on the comparative effectiveness of drugs.2 In the report dated December 13, 2005, AHRQ concluded that there was no difference in effectiveness in relieving the symptoms of GERD among the 5 proton pump inhibitors (PPIs: Aciphex, Nexium, Prevacid, Protonix, and omeprazole in its marketed forms, brand Prilosec, Prilosec OTC [over the counter], and generic [prescription only] omeprazole). In the 1-page summary for consumers, AHRQ experts state that studies show that, overall, each PPI works about as well as another for relieving symptoms. Since Prilosec OTC has an average price of $0.62 per day ($19 per month) in 2006, it is possible to treat about 6 to 7 patients with Prilosec OTC for the same price as treating just 1 patient with any of the other brand-name PPIs (Table 1).