Long-term cost-effectiveness of medical, endoscopic and surgical management of gastroesophageal reflux disease

Luke M. Funk, James Y. Zhang, Joseph M. Drosdeck, W. Scott Melvin, John P. Walker, Kyle A. Perry

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background The long-term cost effectiveness of medical, endoscopic, and operative treatments for adults with gastroesophageal reflux disease (GERD) remains unclear. We sought to estimate the cost effectiveness of medical, endoscopic, and operative treatments for adults with GERD who require daily proton pump inhibitor (PPI) therapy.

Methods A Markov model was generated from the payer's perspective using a 6-month cycle and 30-year time horizon. The base-case patient was a 45-year-old man with symptomatic GERD taking 20 mg of omeprazole twice daily. Four treatment strategies were analyzed: PPI therapy, transoral incisionless fundoplication (EsophyX), radiofrequency energy application to the lower esophageal sphincter (Stretta) and laparoscopic Nissen fundoplication. The model parameters were selected using the published literature and institutional billing data. The main outcome measure was the incremental cost-effectiveness ratio (cost per quality-adjusted life-year gained) for each therapy.

Results In the base case analysis, which assumed a PPI cost of $234 over 6 months ($39 per month), Stretta and laparoscopic Nissen fundoplication were the most cost-effective options over a 30-year time period ($2,470.66 and $5,579.28 per QALY gained, respectively). If the cost of PPI therapy exceeded $90.63 per month over 30 years, laparoscopic Nissen fundoplication became the dominant treatment option. EsophyX was dominated by laparoscopic Nissen fundoplication at all points in time.

Conclusion Low-cost PPIs, Stretta, and laparoscopic Nissen fundoplication all represent cost-effective treatment strategies. In this model, when PPIs exceed $90 per month, medical therapy is no longer cost effective. Procedural GERD therapy should be considered for patients who require high-dose or expensive PPIs.

Original languageEnglish (US)
Pages (from-to)126-136
Number of pages11
JournalSurgery (United States)
Volume157
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Gastroesophageal Reflux
Cost-Benefit Analysis
Fundoplication
Proton Pump Inhibitors
Costs and Cost Analysis
Therapeutics
Quality-Adjusted Life Years
Lower Esophageal Sphincter
Omeprazole
Health Care Costs
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Long-term cost-effectiveness of medical, endoscopic and surgical management of gastroesophageal reflux disease. / Funk, Luke M.; Zhang, James Y.; Drosdeck, Joseph M.; Melvin, W. Scott; Walker, John P.; Perry, Kyle A.

In: Surgery (United States), Vol. 157, No. 1, 01.01.2015, p. 126-136.

Research output: Contribution to journalArticle

Funk, Luke M. ; Zhang, James Y. ; Drosdeck, Joseph M. ; Melvin, W. Scott ; Walker, John P. ; Perry, Kyle A. / Long-term cost-effectiveness of medical, endoscopic and surgical management of gastroesophageal reflux disease. In: Surgery (United States). 2015 ; Vol. 157, No. 1. pp. 126-136.
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AB - Background The long-term cost effectiveness of medical, endoscopic, and operative treatments for adults with gastroesophageal reflux disease (GERD) remains unclear. We sought to estimate the cost effectiveness of medical, endoscopic, and operative treatments for adults with GERD who require daily proton pump inhibitor (PPI) therapy.Methods A Markov model was generated from the payer's perspective using a 6-month cycle and 30-year time horizon. The base-case patient was a 45-year-old man with symptomatic GERD taking 20 mg of omeprazole twice daily. Four treatment strategies were analyzed: PPI therapy, transoral incisionless fundoplication (EsophyX), radiofrequency energy application to the lower esophageal sphincter (Stretta) and laparoscopic Nissen fundoplication. The model parameters were selected using the published literature and institutional billing data. The main outcome measure was the incremental cost-effectiveness ratio (cost per quality-adjusted life-year gained) for each therapy.Results In the base case analysis, which assumed a PPI cost of $234 over 6 months ($39 per month), Stretta and laparoscopic Nissen fundoplication were the most cost-effective options over a 30-year time period ($2,470.66 and $5,579.28 per QALY gained, respectively). If the cost of PPI therapy exceeded $90.63 per month over 30 years, laparoscopic Nissen fundoplication became the dominant treatment option. EsophyX was dominated by laparoscopic Nissen fundoplication at all points in time.Conclusion Low-cost PPIs, Stretta, and laparoscopic Nissen fundoplication all represent cost-effective treatment strategies. In this model, when PPIs exceed $90 per month, medical therapy is no longer cost effective. Procedural GERD therapy should be considered for patients who require high-dose or expensive PPIs.

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