Efficacy, safety and cost-effectiveness of potassium-competitive acid blockers versus proton pump inhibitors in gastroesophageal reflux disease

Background To evaluate the efficacy and safety of potassium-competitive acid blockers (P-CABs) versus proton pump inhibitors (PPIs) in the treatment of gastroesophageal reflux disease (GERD) through a meta-analysis, explores the preliminary pharmacoeconomic advantages.Methods Randomized controlled trials (RCTs) comparing P-CABs and PPIs for GERD treatment were identified from database, up to July 2025. After processing the studies and extracting the data. RevMan and Stata was used for data analysis. A preliminary pharmacoeconomic analysis was performed based on market survey data.Results A total of 10 RCTs (5133 participants) were included. P-CABs demonstrated better overall efficacy than PPIs [risk ratio (RR) = 0.72, P = 0.02]. Sensitivity analysis indicated higher applicability in Asian populations (RR = 0.69, P = 0.01). Subgroup analysis showed P-CABs had a significant advantage over lansoprazole (P < 0.001, RR = 0.50), but not over esomeprazole (P = 0.93). P-CABs were superior in the low-dose group, 2-week and 8-week treatment courses group. In the high-dose P-CABs group, 4-week treatment courses group, heartburn relief group and adverse event rates were comparable to PPIs. Pharmacoeconomic analysis revealed that CERP-CABs ≈ 0.1 CNY/day (d)/1%cure rate (1%CR); CERPPIs ≈ 0.01 CNY/d/1%CR; ICER = 3.125 CNY/d/1%CR.Conclusions P-CABs demonstrate relatively greater efficacy than PPIs, especially in Asian populations. However, in terms of symptom relief, mid-term efficacy and safety both classes show comparable effects. PPIs are more cost-effective in specific contexts. Due to the limited follow-up duration in the included studies, the conclusions are applicable only to short-term symptom control.