OBJECTIVE  To evaluate the effectiveness and safety of vonoprazan(VPZ) and proton pump inhibitors(PPIs) in the treatment of artificial ulcers after endoscopic mucosal dissection(ESD), and further evaluate their economics.

METHODS A systematic evaluation of the effectiveness and safety of VPZ and PPIs in the application of artificial ulcers after ESD was conducted through database retrieval, and economic analysis was performed.

RESULTS  A total of 9 randomized control trial studies and 6 cohort studies involving 3644 patients were included. The meta-analysis results showed that there was no statistically significant difference between the VPZ group and the PPIs group in the following aspects after ESD: 4-week ulcer healing rateRR=0.93, 95%CI(0.69, 1.25), P=0.63, 8-week ulcer healing rateRR=1.00, 95%CI(0.95, 1.06), P=0.89, 4-week ulcer shrinkage rateMD=0.42, 95%CI(−0.71, 1.54), P=0.47 and incidence of delayed bleeding within 8 weeks of different strategies after surgeryRR=0.55, 95%CI(0.27, 1.12), P=0.1; RR=0.82, 95%CI(0.68, 1.00), P=0.05. There was no statistically significant difference in the occurrence of drug-related adverse reactions between the two groups, except for abdominal pain. Due to the two groups had similar therapeutic effects, cost minimization analysis was applied. The results showed that the treatment costs of patients in the VPZ group were higher than those in the PPIs group under different intervention treatments. Sensitivity analysis showed stable results.

CONCLUSION Current evidence suggests that VPZ is not superior to PPIs in the treatment of artificial ulcers after ESD. Based on current drug pricing and patient economic considerations, PPIs is considered to be more cost-effective.