Skip to main content
Log in

Economic Evaluations of Gastroesophageal Reflux Disease Medical Management

  • Systematic Review
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Background

Gastroesophageal reflux disease (GERD) contributes to substantial medication use and costs worldwide. Economic evaluations provide insight into the value of healthcare, taking into account cost, quality, and benefits of particular treatments.

Objectives

Our objectives were to systematically review the existing literature to identify economic evaluations of GERD management strategies, to assess the scientific quality of these reports, and to summarize the economic outcomes of these evaluations.

Methods

We identified economic evaluations and cost studies of GERD management strategies by searching PubMed and the UK NHS Economic Evaluation Database via the Cochrane Library. Searching was restricted to articles in English-language journals from July 2003 to July 2013. Cost-identification articles were excluded from the final analysis.

Results

Eighteen articles were included in the final analysis; 61 % of these met all criteria for quality reporting. Overall, proton pump inhibitor (PPI) therapy was preferred (most effective and least costly) as empiric therapy for patients with reflux symptoms, except in patient populations with high Helicobacter pylori prevalence (>40 %). Initial empiric PPI therapy (vs. initial endoscopy stratification or H. pylori testing) is likely the most cost-effective initial strategy for patients with typical GERD symptoms. Surgery may be cost effective in patients with chronic GERD symptoms at time horizons of 3–10 years. Endoscopic anti-reflux procedures were not cost effective based on available data.

Conclusions

Further economic evaluations should adhere to standard reporting measures of cost estimates and outcomes, and should attempt to account for and compare the large heterogeneity of patient phenotypes and treatment effects seen with anti-reflux therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143:1179–87.

    Article  PubMed Central  PubMed  Google Scholar 

  2. El-Serag HB. Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol. 2007;5:17–26.

    Article  PubMed  Google Scholar 

  3. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases. Gastroenterology. 2009;136:376–86.

    Article  PubMed  Google Scholar 

  4. Shaheen N, Hansen R, Morgan D, Gangarosa L, Ringel Y, Thiny M, et al. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol. 2006;101:2128–38.

    Article  PubMed  Google Scholar 

  5. Levin TR, Schmittdiel JA, Kunz K, Henning JM, Henke CJ, et al. Costs of acid-related disorders to a health maintenance organization. Am J Med. 1997;103(6):520–8.

    Article  CAS  PubMed  Google Scholar 

  6. DrugTopics website: pharmacy facts and figures. http://drugtopics.modernmedicine.com/Pharmacy+Facts+&+Figures.

  7. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)—explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013;16:231–50.

    Article  PubMed  Google Scholar 

  8. Grant AM, Boachie C, Cotton SC, Faria R, Bojke L, Epstein DM, et al. Clinical and economic evaluation of laparoscopic surgery compared with medical management for gastro-oesophageal reflux disease: 5-year follow-up of multicentre randomised trial (the REFLUX trial). Health Technol Assess. 2013;17:1–167.

    CAS  PubMed  Google Scholar 

  9. Comay D, Adam V, da Silveira EB, Kennedy W, Mayrand S, Barkun AN. The Stretta procedure versus proton pump inhibitors and laparoscopic Nissen fundoplication in the management of gastroesophageal reflux disease: a cost-effectiveness analysis. Can J Gastroenterol. 2008;22:552–8.

    PubMed Central  PubMed  Google Scholar 

  10. Arguedas MR, Heudebert GR, Klapow JC, Centor RM, Eloubeidi MA, Wilcox CM, et al. Re-examination of the cost-effectiveness of surgical versus medical therapy in patients with gastroesophageal reflux disease: the value of long-term data collection. Am J Gastroenterol. 2004;99:1023–8.

    Article  PubMed  Google Scholar 

  11. Cookson R, Flood C, Koo B, Mahon D, Rhodes M. Short-term cost effectiveness and long-term cost analysis comparing laparoscopic Nissen fundoplication with proton-pump inhibitor maintenance for gastro-oesophageal reflux disease. Br J Surg. 2005;92:700–6.

    Article  CAS  PubMed  Google Scholar 

  12. Epstein D, Bojke L, Sculpher MJ. Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: cost effectiveness study. BMJ. 2009;339:b2576.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Grant A, Wileman S, Ramsay C, Bojke L, Epstein D, Sculpher M, et al. The effectiveness and cost-effectiveness of minimal access surgery amongst people with gastro-oesophageal reflux disease—a UK collaborative study. The REFLUX trial. Health Technol Assess. 2008;12:1–181, iii–iv.

  14. Bojke L, Hornby E, Sculpher M. A comparison of the cost effectiveness of pharmacotherapy or surgery (laparoscopic fundoplication) in the treatment of GORD. Pharmacoeconomics. 2007;25:829–41.

    Article  PubMed  Google Scholar 

  15. Goeree R, Hopkins R, Marshall JK, Armstrong D, Ungar WJ, Goldsmith C, et al. Cost-utility of laparoscopic Nissen fundoplication versus proton pump inhibitors for chronic and controlled gastroesophageal reflux disease: a 3-year prospective randomized controlled trial and economic evaluation. Value Health. 2011;14:263–73.

    Article  PubMed  Google Scholar 

  16. Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V. Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. Am J Gastroenterol. 2008;103:267–75.

    Article  CAS  PubMed  Google Scholar 

  17. You JHS, Wong P-L, Wu JCY. Cost-effectiveness of Helicobacter pylori “test and treat” for patients with typical reflux symptoms in a population with a high prevalence of H. pylori infection: a Markov model analysis. Scand J Gastroenterol. 2006;41:21–9.

    Article  PubMed  Google Scholar 

  18. Doan QV, Lange SM, Elfant A, Aguilar D, Reyes E, Lynn RB, et al. Disease-specific cost savings of treating nighttime versus daytime gastroesophageal reflux disease in an employed population. J Med Econ. 2008;11:23–40.

    Article  PubMed  Google Scholar 

  19. Moayyedi P, Armstrong D, Hunt RH, Lei Y, Bukoski M, White RJ. The gain in quality-adjusted life months by switching to esomeprazole in those with continued reflux symptoms in primary care: EncomPASS—a cluster-randomized trial. Am J Gastroenterol. 2010;105:2341–6.

    Article  CAS  PubMed  Google Scholar 

  20. You JHS, Lee ACM, Won SCYG, Anà FKLCH, Wong SCY, Chan FKL. Low-dose or standard-dose proton pump inhibitors for maintenance therapy of gastro-oesophageal reflux disease: a cost-effectiveness analysis. Aliment Pharmacol Ther. 2003;17:785–92.

    Article  CAS  PubMed  Google Scholar 

  21. Remák E, Brown RE, Yuen C, Robinson A. Cost-effectiveness comparison of current proton-pump inhibitors to treat gastro-oesophageal reflux disease in the UK. Curr Med Res Opin. 2005;21:1505–17.

    Article  PubMed  Google Scholar 

  22. Harewood GC, Gostout CJ. Cost analysis of endoscopic antireflux procedures: endoluminal plication vs. radiofrequency coagulation vs. treatment with a proton pump inhibitor. Gastrointest Endosc. 2003;58:493–9.

    PubMed  Google Scholar 

  23. Habu Y, Maeda K, Kusuda T, Yoshino T, Shio S, Yamazaki M, et al. “Proton-pump inhibitor-first” strategy versus “step-up” strategy for the acute treatment of reflux esophagitis: a cost-effectiveness analysis in Japan. J Gastroenterol. 2005;40:1029–35.

    Article  CAS  PubMed  Google Scholar 

  24. Baldi F, Cavoli C, Ghersi S, Mantovani L, Torresan F, Roda E. Cost-effectiveness of different diagnostic strategies to assess gastro-oesophageal reflux disease in patients with unexplained chronic persistent cough in Italy. Dig Liver Dis. 2006;38:452–8.

    Article  CAS  PubMed  Google Scholar 

  25. Gosselin A, Luo R, Lohoues H, Toy E, Lewis B, Crawley J, et al. The impact of proton pump inhibitor compliance on health-care resource utilization and costs in patients with gastroesophageal reflux disease. Value Health. 2009;12:34–9.

    Article  PubMed  Google Scholar 

  26. Klapow JC, Wilcox CM, Mallinger AP, Marks R, Heudebert GR, Centor RM, et al. Characterization of long-term outcomes after Toupet fundoplication: symptoms, medication use, and health status. J Clin Gastroenterol. 2002;34:509–15.

    Article  PubMed  Google Scholar 

  27. Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383–91.

    Article  PubMed  Google Scholar 

  28. Kahrilas PJ, Shaheen NJ, Vaezi MF. American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1392–413.

    Article  PubMed  Google Scholar 

  29. Rotman SR, Bishop TF. Proton pump inhibitor use in the U.S. ambulatory setting, 2002–2009. PLoS One. 2013;8:e56060.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA. 2001;285:2331–8.

    Article  CAS  PubMed  Google Scholar 

  31. Lundell L. Surgical therapy of gastro-oesophageal reflux disease. Best Pract Res Clin Gastroenterol. 2010;24:947–59.

    Article  PubMed  Google Scholar 

  32. Gatenby P, Bann S. Antireflux surgery. Minerva Chir. 2009;64:169–81.

    CAS  PubMed  Google Scholar 

  33. Zhao Y, Encinosa W. Gastroesophageal reflux disease (GERD) hospitalizations in 1998 and 2005. HCUP Statistical Brief #44. 2008;2340–8. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb44.pdf. Accessed 29 Apr 2014.

  34. Ganz RA, Peters JH, Horgan S, Bemelman WA, Dunst CM, Edmundowicz SA, et al. Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med. 2013;368:719–27.

    Article  CAS  PubMed  Google Scholar 

  35. Ahmed TF, Khandwala F, Abelson TI, Hicks DM, Richter JE, Milstein C, et al. Chronic laryngitis associated with gastroesophageal reflux: prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians. Am J Gastroenterol. 2006;101:470–8.

    Article  PubMed  Google Scholar 

  36. Bretagne JF, Honnorat C, Richard-Molard B, Soufflet C, Barthelemy P. Perceptions and practices on the management of gastro-oesophageal reflux disease: results of a national survey comparing primary care physicians and gastroenterologists. Aliment Pharmacol Ther. 2007;25:823–33.

    Article  PubMed  Google Scholar 

  37. Chey WD, Mody RR, Wu EQ, Chen L, Kothari S, Persson B, et al. Treatment patterns and symptom control in patients with GERD: US community-based survey. Curr Med Res Opin. 2009;25:1869–78.

    Article  PubMed  Google Scholar 

  38. Chey WD, Inadomi JM, Booher AM, Sharma VK, Fendrick AM, Howden CW. Primary-care physicians’ perceptions and practices on the management of GERD: results of a national survey. Am J Gastroenterol. 2005;100:1237–42.

    Article  PubMed  Google Scholar 

  39. Gawron AJ, Pandolfino JE, Miskevics S, Lavela SL. Proton pump inhibitor prescriptions and subsequent use in US Veterans diagnosed with gastroesophageal reflux disease. J Gen Intern Med. 2013;28:930–7.

    Article  PubMed Central  PubMed  Google Scholar 

  40. AHRQ Executive Summary. Effective health care program management strategies for gastroesophageal reflux disease: an update.

Download references

Acknowledgments

Financial support

Dr. Gawron was previously supported by a National Research Service Award postdoctoral fellow at the Institute for Healthcare studies under an institutional award from the Agency for Healthcare Research and Quality, T-32 HS 000078 (PI: Jane L. Holl, MD MPH). Dr. Pandolfino is supported by R01 DK079902 and R01 DK092217 from the Public Health Service.

Declaration of interests

Drs. Gawron and French have no outside interests to declare.

Dr. Pandolfino has served as a consultant for Given Imaging.

Dr. Howden has served as a consultant and speaker for Takeda, Otsuka, Ironwood and Forest, and as a speaker for GlaxoSmithKline International.

Author contributions

Andrew J. Gawron: guarantor of study, study design, design and modification of literature search, literature assessment and analysis, initial draft, and revision of manuscript.

Dustin D. French: design and modification of literature search, literature assessment and analysis, revision of manuscript.

John E. Pandolfino: study design, provided clinical content expertise and interpretation of results, revision of manuscript.

Colin W. Howden: study design, design and modification of literature search, revision of manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew J. Gawron.

Appendix

Appendix

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gawron, A.J., French, D.D., Pandolfino, J.E. et al. Economic Evaluations of Gastroesophageal Reflux Disease Medical Management. PharmacoEconomics 32, 745–758 (2014). https://doi.org/10.1007/s40273-014-0164-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-014-0164-8

Keywords

Navigation