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Surgical vs. Medical Therapy for GERD: A Cost Comparison

Therapy for gastroesophageal reflux disease (GERD) has undergone many advances during the last decade. Proton-pump inhibitors (PPIs) are the standard of care for medical therapy, and laparoscopic fundoplication is the standard for surgical therapy. Although both approaches are effective, their costs are considerable: Surgery engenders extensive initial costs, whereas medical therapy engenders ongoing costs. Prospective direct cost comparisons of the 2 approaches are lacking. Researchers used data from a prospective, randomized, multicenter trial to conduct an economic analysis of PPI therapy versus surgery for GERD.

The study was carried out in Denmark, Finland, Norway, and Sweden and involved patients with GERD who were treated initially with omeprazole for as long as 4 months. Patients with successful treatment responses received either laparoscopic surgery (154 patients) or continuation of the same dose of omeprazole used to heal the esophagitis (20 or 40 mg; 144 patients). Indirect costs (lost or missed employment, sick leave, transportation) were measured using a health economic questionnaire. Surgery, endoscopy, medication use, and follow-up medical visits (including transportation) were included in direct costs.

The difference in cumulative direct costs significantly favored medical therapy in Denmark (US$1475), Norway (US$5155), and Sweden (US$1946); in Finland, the cost of surgery was lower than medical therapy (by US$1599). However, when indirect costs were included, the cost advantage for medical therapy was significant in all countries: Denmark (US$37,953), Norway (US$57,522), Sweden (US$48,222), and Finland (US$4869).

Comment: These results suggest surgical costs for GERD exceed 5-year costs for medical therapy with omeprazole. Prospective determination of costs as they were incurred (rather than relying on modeling data) improved the precision of cost measurement. Recent 10-year data indicate that most surgical patients return to medical therapy, so overall surgical costs are unlikely to be lower than costs of extended PPI therapy (JW Gastro Jul 2001, p. 60, accession number 010613001, and JAMA 2001 May 9; 285:2331). Therefore, surgery should not be considered a cost-saving treatment for GERD, despite the relatively high price of PPI therapy.

— David A. Johnson, MD

Published in Journal Watch Gastroenterology January 16, 2002

Citation(s):

Myrvold HE et al. The cost of long term therapy for gastro-oesophageal reflux disease: A randomized trial comparing omeprazole and open antireflux surgery. Gut 2001 Oct; 49:488-94.

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