Endoluminal gastroplication and radiofrequency coagulation of the lower esophageal sphincter and gastroesophageal junction are endoscopic therapies for GERD.
In this study, physicians from the United States compared the costs of these endoscopic therapies with each other and with a proton pump inhibitor (PPI) for the treatment of GERD.
A cost minimization approach was used.
| For patients on once-daily PPI, medication is the most economical option.|
The team evaluated patients with GERD who were responsive to daily or twice daily administration of a PPI.
In addition, the performance characteristics of endotherapy were determined from published data.
The cost data for endotherapy were calculated from per case instrumentation costs plus professional fees plus facility fees for ambulatory patient classification codes.
While the PPI treatment cost was based on the national average wholesale price.
The team set the endpoint as sustained resolution of GERD symptoms.
The physicians found that in patients requiring twice daily use of a PPI, endotherapy is the most economical strategy after 17 months.
However, if uniform endotherapy failure rates over time are assumed, medication is cost effective after 29 months.
The team's sensitivity analysis revealed that a PPI remains the most economical option beyond 3 years, provided annual endotherapy failure rates remain over a certain threshold.
The physicians determined that, for patients who experience symptom relief on once-daily PPI, medication remains the most economical option.
Drs Gavin Harewood and Christopher Gostout concluded, "Endotherapy appears to offer an economical treatment option for patients requiring a proton pump inhibitor twice daily, with its cost superiority enduring for 2.5 years".
"More long-term follow-up data are required to determine the durability of the endotherapy benefit over time".