Table 3.

Scores and key comments of 13 criteria for VPZ and TPZ

Criteria	Scores (mean ± SD)	Comments
Disease severity	2.9 ± 0.6	Morbidity: There was no elevated risk of all-cause mortality associated with GERD. Progression: Most patients remained stable or showed improvement in their grade of esophagitis in 5 years. There was a positive association between reflux symptoms and the risk of esophageal adenocarcinoma. Quality of life: Respondents with GERD experienced heartburn, eating and drinking problems, sleep impairment, reduced work productivity, etc.
Size of the affected population	3.5 ± 1.1	Age-standardized prevalence of GERD in China is below 5%. Around 3,000 patients annually have been diagnosed with GERD in the study’s host hospital.
Unmet needs	4.2 ± 0.6	PPI response rate: 10–54% of patients with GERD symptoms failed to respond to a standard-dose PPI. PPI compliance: PPIs are used before meals and take 3–5 days to achieve a steady-state antisecretory effect. Nocturnal acid breakthrough: More than 70% of patients treated with PPIs had NAB. Genetic polymorphism: CYP2C19 genetic polymorphism causes significant inter-individual pharmacodynamic variability with PPI treatment.
Comparative effectiveness	VPZ 3.9 ± 1.1 TPZ 3.4 ± 1.0	VPZ and TPZ are non-inferior to PPIs for patients with GERD. VPZ may be more effective than PPIs for severe erosive esophagitis. Nocturnal pH ≥ 4 HTRs of VPZ and TPZ were greater than PPIs. 24-hour pH ≥ 4 HTRs of VPZ were greater than PPIs. The acid inhibitory effects of VPZ and TPZ are irrespective of the CYP2C19 genotype.
Comparative safety	VPZ 3.0 ± 0.6 TPZ 3.1 ± 0.5	Safety of VPZ and TPZ is comparable with PPIs.
Comparative patient-perceived health	VPZ 2.5 ± 1.0 TPZ 2.4 ± 1.2	There were no substantial differences in improvement of heartburn between VPZ and PPIs. Nocturnal heartburn improvement of VPZ and TPZ was greater than PPIs.
Type of preventive benefit	VPZ 3.6 ± 0.9 TPZ 3.4 ± 1.0	Long-term maintenance therapy and on-demand therapy with VPZ and TPZ can reduce the GERD recurrence rate.
Type of therapeutic benefit	VPZ 4.1 ± 0.9 TPZ 3.8 ± 1.1	The therapeutic target is to relieve symptoms, heal, prevent complications, and improve health-related quality of life. The therapeutic effect is mainly shown in improvement of reflux esophagitis healing rate, GerdQ/FSSG/GOS scores, heartburn symptoms, etc.
Costs of intervention	VPZ 0.9 ± 0.7 TPZ − 0.6 ± 0.5	In 2022, China’s per capita disposable income reached ¥36,883. The treatment phase takes 8 weeks, VPZ costs ¥558.88, and TPZ costs ¥626.08. The maintenance phase, VPZ costs ¥4.945 daily, TPZ costs ¥5.59 daily.
Other medical costs	VPZ 1.3 ± 0.9 TPZ 0	VPZ generates incremental QALYs at a lower cost compared with PPIs. TPZ retrieved no evidence.
Non-medical costs	VPZ 0 TPZ 0	Neither VPZ nor TPZ retrieved evidence.
Quality of evidence	2.4 ± 0.7	The quality of evidence on which the comparison data are based is highly relevant and valid. There is still a lack of direct comparisons between VPZ and TPZ.
Expert consensus/clinical practice guidelines	3.5 ± 1.0	The results of the current expert opinions and clinical practice guidelines clearly indicate that PPIs and P-CABs are the first-line treatment for GERD.

Notes: VPZ, vonoprazan; TPZ, tegoprazan; GERD, gastroesophageal reflux disease; NAB, nocturnal acid breakthrough; PPIs, proton-pump inhibitors; CYP2C19, cytochrome P450 2C19; pH ≥ 4 HTR, pH ≥ 4 holding time ratio; GerdQ, GERD questionnaire; FSSG, Frequency Scale for the Symptoms of GERD; GOS, Global Overall Symptom; QALYs, quality adjusted life years; P-CABs, potassium-competitive acid blockers