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
The hiatus is an opening in the diaphragm (a muscle separating the abdomen and chest) that the esophagus, or swallowing tube, passes through to reach the stomach. If the hiatus weakens and stretches, part of the stomach and/or the esophagus can squeeze into the chest cavity, producing a hiatal hernia.
There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).
In a sliding hiatal hernia, the stomach and the esophagus slide up into the chest through the...
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.