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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Article info
Publication history
Published online: September 25, 2014
Accepted:
May 30,
2014
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
