A team from Scandinavia evaluated the direct and indirect costs of medical and surgical therapy for gastro-esophageal reflux disease (GERD).
Some 298 reflux esophagitis patients were enrolled in the prospective multicenter trial.
Subjects were initially treated with omeprazole to control symptoms and to heal esophagitis.
Then 154 patients were randomized to continue treatment with omeprazole (20 or 40 mg daily) and 144 patients had an open anti-reflux operation (ARS).
In case of GERD relapse, patients allocated to omeprazole were offered ARS. Those initially operated on had either a reoperation or were treated with omeprazole.
The costs were assessed over 5 years from randomization.
| Direct and indirect costs of antireflux surgery exceed those of medical therapy.
The researchers found that differences in cumulative direct medical costs per patient, between the two therapeutic strategies, diminished with time.
However, 5-year direct medical costs per patient, for those given omeprazole, were still significantly lower than for those having ARS. This was true in Denmark, Norway, and Sweden. The differences were DKK 8703 (US$1475), NOK 32,992 (US$ 5155), and SEK 13,036 (US$ 1946), respectively.
Nevertheless, in Finland the reverse was true: the difference in favor of ARS amounted to FMK 7354 (US$ 1599).
When indirect costs (loss of production due to GERD related sick leave) were also included, the cost of surgical treatment increased substantially and exceeded the cost of medical treatment in all countries.
Professor H. E. Myrvold, of the Trondheim University Hospital, Norway, concluded on behalf of colleagues, "The total costs of medical therapy for chronic GERD were lower than those of open ARS, when prospectively assessed over a 5-year period.
"However, significant differences in cost estimates were revealed between countries."