Abstracts
1997 Digestive Disease Week

Economic analysis of treatment options for severe GERD: laparoscopic Nissen fundoplication versus medical management.

PR Schauer, D Axelrod, J Pitts, S Guraisco, D Centers, TN Pappas, WS Eubanks. Departments of Surgery and Medicine, Duke University Medical Center, Durham, NC.

This multi-institutional study evaluated the relative long-term costs of surgical vs. medical management of severe GERD. Methods: The costs estimates were derived from a standard discounted cash flow model. Costs represent estimates of direct and indirect costs and professional fees. Data from the medical records of 343 patients undergoing laparoscopic Nissen fundoplication (LNF) by 12 surgeons were analyzed for determination of procedure related costs. All patients had severe GERD. For determination of medical costs prior to surgery, the office records of 144 of the 343 patients treated by 8 gastroenterologists were analyzed.

Results:

                          Cost of Medical Management (N=144)
Cost component        Mean Yearly Cost(0       Projected 10 year
                                               Discounted Cost (0
Medication*                1,352                   10,440
Office Visits                115                      888
Medical Tests                196                    1,955
Lost Work Time               525                    4,053
Total                     ,188                  ,336
    *84% of patients were on maintenance Omeprazole therapy

                             Cost of Surgical Management (N=344)
 Cost component         Mean perioperative        Projected 10 year
                             Cost (0             Discounted Cost(0
 Preop. Tests                  1,196                    1,196
 Operation costs#             11,873                   11,873
 Postop. costs†                  718                    2,050
 Lost work Time                  750                      750
 Total                       ,233                  ,869
 #includes professional fees, † includes cost of surgical failures

Conclusion: Medication and direct operating costs were the dominating cost components for each mode of therapy. This study suggests that LNF compared to medical therapy results in a costs savings over a 10 year period. The cost of medical and surgical management for patients with severe GERD is equal at approximately 8 years, beyond which medical therapy exceeds the cost of LNF.