Even though it cuts the need for anti-acid drugs, GERD surgery isn't cost-effective in the short term.
GERD -- gastroesophageal reflux disease -- happens when the valve between the stomach and the esophagus doesn't work right. This lets acid escape the stomach and burn its way up the esophagus. Several types of drugs can help. So can surgery. Which costs less? Erin M. Sullivan, PhD, and colleagues at Boston Scientific Corp. and Cleveland Clinic Foundation took a look.
Your description of your symptoms may be all a doctor requires to diagnose heartburn, but sometimes additional testing may be necessary. The esophagus can be viewed through an endoscope, a long, thin, flexible tube inserted through the mouth, or by X-ray.
Sometimes, your doctor may recommend a 24-hour esophageal pH probe study, especially if you have unusual symptoms, such as throat or chest or abdominal pain, coughing, or asthma-like symptoms. In this test, a long, narrow, flexible tube is inserted...
Sullivan's team matched 123 GERD patients who opted for surgery with 246 GERD patients who stayed on drug therapy. In the year before their operations, the surgery patients had higher medical costs due partly to more GERD-related treatment and partly to more medical tests. After their operations, Surgery patients averaged 62% fewer days on GERD drugs than non-surgery patients. Even so, their overall medical costs were higher for the 18 months after their operations.
"The assumption has been that the one-time cost of surgery is lower than the long-term cost of drugs, but we found that the surgery costs were not offset by the reduction in medication costs during an 18-month follow-up period," Sullivan says in a press release.
It remains to be seen whether surgery will prove cost effective over longer periods of time.
Surgery for GERD is called fundoplication. In this operation, the upper curve of the stomach is wrapped around the esophagus and sewn into place. This lets the lower part of the esophagus pass through a small tunnel of stomach muscle. This strengthens the valve between the esophagus and stomach, making it harder for acid to back up into the esophagus.
Sullivan reported the study findings at this weeks meeting of the American College of Gastroenterology.