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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(07): E923-E932
DOI: 10.1055/a-1783-9378
Original article

Transoral incisionless fundoplication is cost-effective for treatment of gastroesophageal reflux disease

Thomas R. McCarty
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
,
Pichamol Jirapinyo
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
,
Lyndon P. James
3   Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States
4   PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, United States
,
Sanchit Gupta
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
,
Walter W. Chan
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
,
Christopher C. Thompson
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
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Abstract

Background and study aims Given the sizable number of patients with symptomatic gastroesophageal reflux disease (GERD) despite proton pump inhibitor (PPI) therapy, non-pharmacologic treatment has become increasingly utilized. The aim of this study was to analyze the cost-effectiveness of medical, endoscopic, and surgical treatment of GERD.

Patients and methods A deterministic Markov cohort model was constructed from the US healthcare payer’s perspective to evaluate the cost-effectiveness of three competing strategies: 1) omeprazole 20 mg twice daily; 2) transoral incisionless fundoplication (TIF 2.0); and 3) laparoscopic Nissen fundoplication [LNF]. Cost was reported in US dollars with health outcomes recorded in quality-adjusted life years (QALYs). Ten-year and lifetime time horizons were utilized with 3 % discount rate and half-cycle corrections applied. The main outcome was incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of $ 100,000 per QALY. Probabilistic sensitivity analyses were also performed.

Results In our base-case analysis, the average cost of TIF 2.0 was $ 13,978.63 versus $ 17,658.47 for LNF and $ 10,931.49 for PPI. Compared to the PPI strategy, TIF 2.0 was cost-effective with an incremental cost of $ 3,047 and incremental effectiveness of 0.29 QALYs, resulting in an ICER of $ 10,423.17 /QALY gained. LNF was strongly dominated by TIF 2.0. Over a lifetime horizon, TIF 2.0 remained the cost-effective strategy for patients with symptoms despite twice-daily 20-mg omeprazole. TIF 2.0 remained cost-effective after varying parameter inputs in deterministic and probabilistic sensitivity analyses and for scenario analyses in multiple age groups.

Conclusions Based upon this study, TIF 2.0 was cost-effective for patients with symptomatic GERD despite low-dose, twice-daily PPI.

Supplementary material



Publication History

Received: 14 July 2021

Accepted after revision: 19 October 2021

Article published online:
15 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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