Re-examination of the cost-effectiveness of surgical versus medical therapy in patients with gastroesophageal reflux disease: The value of long-term data collection

Miguel R. Arguedas, Gustavo R. Heudebert, Joshua C. Klapow, Robert M. Centor, Mohamad A. Eloubeidi, C. Mel Wilcox, Stuart Jon Spechler

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

OBJECTIVES: For patients with reflux esophagitis, long-term therapeutic options include proton pump inhibitor (PPI) therapy and/or antireflux surgery. An earlier cost-effectiveness analysis concluded that at 5 yr, medical therapy was less expensive but similarly effective to fundoplication, but the results were sensitive to estimates on quality of life and long-term medication usage, which were derived from "expert opinion." Recently, data from randomized controlled trials addressing these variables have become available. We have incorporated these new data into a revised Markov model to examine the cost-effectiveness of surgical versus medical therapy in patients with severe reflux esophagitis. METHODS: A Markov simulation model was constructed using specialized software (DATA PRO 4.0, Williamstown, MA). Total expected costs and quality-adjusted life-years were calculated for long-term medical therapy and for laparoscopic Nissen fundoplication. Probabilities were obtained from the medical literature using Medline®. Procedural and hospitalization costs used were the average Medicare reimbursements at our institution. Medication costs were the average wholesale price. The analysis was extended over a 10-yr time horizon at a discount rate of 3%. RESULTS: The discounted analysis shows that medical therapy is associated with total costs of $8,798 and 4.59 quality-adjusted life-years, whereas the surgical strategy is more expensive ($10,475) and less effective (4.55 quality-adjusted life-years). The results were robust to most one-way sensitivity analyses. CONCLUSIONS: Long-term medical therapy with PPI is the preferred strategy for patients with gastroesophageal reflux disease and severe esophagitis. Our study highlights the importance of using primary, patient-derived data rather than expert opinion.

Original languageEnglish (US)
Pages (from-to)1023-1028
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume99
Issue number6
DOIs
StatePublished - Jun 2004

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Gastroesophageal Reflux
Cost-Benefit Analysis
Quality-Adjusted Life Years
Costs and Cost Analysis
Fundoplication
Peptic Esophagitis
Proton Pump Inhibitors
Expert Testimony
Therapeutics
Esophagitis
Medicare
Hospitalization
Software
Randomized Controlled Trials
Quality of Life

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Re-examination of the cost-effectiveness of surgical versus medical therapy in patients with gastroesophageal reflux disease : The value of long-term data collection. / Arguedas, Miguel R.; Heudebert, Gustavo R.; Klapow, Joshua C.; Centor, Robert M.; Eloubeidi, Mohamad A.; Wilcox, C. Mel; Spechler, Stuart Jon.

In: American Journal of Gastroenterology, Vol. 99, No. 6, 06.2004, p. 1023-1028.

Research output: Contribution to journalArticle

Arguedas, Miguel R. ; Heudebert, Gustavo R. ; Klapow, Joshua C. ; Centor, Robert M. ; Eloubeidi, Mohamad A. ; Wilcox, C. Mel ; Spechler, Stuart Jon. / Re-examination of the cost-effectiveness of surgical versus medical therapy in patients with gastroesophageal reflux disease : The value of long-term data collection. In: American Journal of Gastroenterology. 2004 ; Vol. 99, No. 6. pp. 1023-1028.
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