Abstract
Background
Gastroesophageal reflux disease is a common condition in Western countries. It is unknown whether medical or surgical treatment is more cost-effective. This study was conducted to determine whether laparoscopic Nissen fundoplication or treatment by proton pump inhibitors is the most cost-effective for gastroesophageal reflux disease in the long term.
Methods
Medline, EMBASE, and Cochrane databases were searched for articles published between January 1990 and 2010. The search results were screened by two independent reviewers for economic evaluations comparing costs and effects of laparoscopic Nissen fundoplication and proton pump inhibitors in adults eligible for both treatments. Cost and effectiveness or utility data were extracted for both treatment modalities. The quality of the economic evaluations was scored using a dedicated checklist, as were the levels of evidence.
Results
Four publications were included; all were based on decision analytic models. The economic evaluations were all of similar quality and all based on data with a variety of evidence levels. Surgery was more expensive than medical treatment in three publications. Two papers reported more quality-adjusted life-years for surgery. However, one of these reported more symptom-free months for medical treatment. In two publications surgery was considered to be the most cost-effective treatment, whereas the other two favored medical treatment.
Conclusions
The results with regard to cost-effectiveness are inconclusive. All four economic models are based on high- and low-quality data. More reliable estimates of cost-effectiveness based on long-term trial data are needed.
Similar content being viewed by others
References
Locke GR III, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ III (1997) Prevalence and clinical spectrum of gastro-oesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 112:1448–1456
Raiha IJ, Impivaara O, Seppala M, Sourander LB (1992) Prevalence and characteristics of symptomatic gastro-oesophageal reflux disease in the elderly. J Am Geriatr Soc 40:1209–1211
Diaz-Rubio M, Moreno-Elola-Olaso C, Rey E, Locke GR, Rodriguez-Artalejo F (2004) Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish population. Aliment Pharmacol Ther 19:95–105
Haque M, Wyeth JW, Stace NH, Talley NJ, Green R (2000) Prevalence, severity and associated features of gastro-oesophageal reflux and dyspepsia: a population-based study. N Z Med J 113:178–181
Bruley Des Varannes S, Marek L, Humeau B, Humeau B, Lecasble M, Colin R (2006) Gastro-oesophageal reflux disease in primary care: prevalence, epidemiology and quality of life of patients. Gastroenterol Clin Biol 30:364–370
Khan M, Santana J, Donnellan C, Preston C, Moayyedi P (2007) Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev 2:CD003244
Stylopoulos N, Rattner DW (2005) The history of hiatal hernia surgery: from Bowditch to laparoscopy. Ann Surg 241:185–193
Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Malm A, Sutherland I, Walan A (2007) Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis. Br J Surg 94:198–203
Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, Raufman JP, Sampliner R, Schnell T, Sontag S, Vlahcevic ZR, Young R, Williford W (2001) Long-term outcome of medical and surgical therapies for gastro-oesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 285:2331–2338
Madan A, Minocha A (2006) Despite high satisfaction, majority of gastro-oesophageal reflux disease patients continue to use proton pump inhibitors after antireflux surgery. Aliment Pharmacol Ther 23:601–605
Drummond MF, Schulper M, Torrance G, O’Brien B, Stoddart G (2005) Methods for the economic evaluation of health care programmes, 3rd edn. Oxford University Press, Oxford
Centre for Evidence-Based Medicine, University of Oxford (2009) Levels of Evidence March 2009. http://www.cebm.net/index.aspx?o=1025. Accessed 1 Jun 2009
Coley CM, Barry MJ, Spechler SJ (1993) Initial medical versus surgical therapy for complicated or chronic gastro-oesophageal reflux disease (GORD): a cost-effectiveness analysis. Gastroenterology 104:A5
Hurley S, Mckeage S, Ngaei G (1996) Cost-effectiveness of primary medical therapy versus surgery for the treatment of gastro-oesophageal reflux disease (GORD). Aust J Hosp Pharm 26:171
Arguedas MR, Heudebert GR, Klapow JC, Centor RM, Eloubeidi MA, Wilcox CM, Spechler SJ (2004) Re-examination of the cost-effectiveness of surgical versus medical therapy in patients with gastro-oesophageal reflux disease: the value of long-term data collection. Am J Gastroenterol 99:1023–1028
Comay D, Adam V, da Silveira EB, Kennedy W, Mayrand S, Barkun AN (2008) The Stretta procedure versus proton pump inhibitors and laparoscopic Nissen fundoplication in the management of gastro-oesophageal reflux disease: a cost-effectiveness analysis. Can J Gastroenterol 22:552–558
Epstein D, Bojke L, Sculpher MJ (2009) Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: cost effectiveness study. BMJ 339:b2576
Romagnuolo J, Meier MA, Sadowski DC (2002) Medical or surgical therapy for erosive reflux esophagitis: cost-utility analysis using a Markov model. Ann Surg 236:191–202
Beck JR, Pauker SG (1983) The Markov process in medical prognosis. Med Decis Making 3:419–458
Peters MJ, Mukhtar A, Yunus RM, Khan S, Pappalardo J, Memon B, Memon MA (2009) Meta-analysis of randomized clinical trials comparing open and laparoscopic anti-reflux surgery. Am J Gastroenterol 104:1548–1561
Draaisma WA, Buskens E, Bais JE, Simmermacher RK, Rijnhart-de Jong HG, Broeders IA, Gooszen HG (2006) Randomized clinical trial and follow-up study of cost-effectiveness of laparoscopic versus conventional Nissen fundoplication. Br J Surg 93:690–697
Rattner DW, Brooks DC (1995) Patient satisfaction following laparoscopic and open antireflux surgery. Arch Surg 130:289–293
Heikkinen TJ, Haukipuro K, Koivukangas P, Sorasto A, Autio R, Södervik H, Mäkelä H, Hulkko A (1999) Comparison of costs between laparoscopic and open Nissen fundoplication: a prospective randomized study with a 3-month followup. J Am Coll Surg 188:368–376
Incarbone R, Peters JH, Heimbucher J, Dvorak D, Bremner CG, DeMeester TR (1995) A contemporaneous comparison of hospital charges for laparoscopic and open Nissen fundoplication. Surg Endosc 9:151–154
Low DE (1995) Examination of outcome and cost data of open and laparoscopic antireflux operations at Virginia Mason Medical Center in Seattle. Surg Endosc 9:1326–1328
Eshraghi N, Farahmand M, Soot SJ, Rand-Luby L, Deveney CW, Sheppard BC (1998) Comparison of outcomes of open versus laparoscopic Nissen fundoplication performed in a single practice. Am J Surg 175:371–374
Harewood GC, Gostout CJ (2003) Cost analysis of endoscopic antireflux procedures: endoluminal plication vs. radiofrequency coagulation vs. treatment with a proton pump inhibitor. Gastrointest Endosc 58:493–499
Wiersema MJ, Levy MJ (2004) Cost analysis of endoscopic antireflux procedures: endoluminal plication vs. radiofrequency coagulation vs. treatment with a proton pump inhibitor. Gastrointest Endosc 59:749–750
Chen D, Barber C, McLoughlin P, Thavaneswaran P, Jamieson GG, Maddern GJ (2009) Systematic review of endoscopic treatments for gastro-oesophageal reflux disease. Br J Surg 96:128–136
Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Engström C (2009) Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Clin Gastroenterol Hepatol 7:1292–1298
Gisbert JP, Cooper A, Karagiannis D, Hatlebakk J, Agréus L, Jablonowski H, Nuevo J (2009) Impact of gastro-oesophageal reflux disease on work absenteeism, presenteeism and productivity in daily life: a European observational study. Health Qual Life Outcomes 7:90
Myrvold HE, Lundell L, Miettinen P, Pedersen SA, Liedman B, Hatlebak J (2001) The cost of long term therapy for gastro-oesophageal reflux disease: a randomised trial comparing omeprazole and open antireflux surgery. Gut 49:488–494
Grant A, Wileman S, Ramsay C, Bojke L, Epstein D, Sculpher M, Macran S, Kilonzo M, Vale L, Francis J, Mowat A, Krukowski Z, Heading R, Thursz M, Russell I, Campbell M (2008) The effectiveness and cost-effectiveness of minimal access surgery amongst people with gastro-oesophageal reflux disease—a UK collaborative study. Health Technol Assess 12:1–181
Bojke L, Hornby E, Sculpher M (2007) A comparison of the cost effectiveness of pharmacotherapy or surgery (laparoscopic fundoplication) in the treatment of GORD. Pharmacoeconomics 25:829–841
Heudebert GR, Marks R, Wilcox CM, Centor RM (1997) Choice of long-term strategy for the management of patients with severe esophagitis: a cost-utility analysis. Gastroenterology 112:1078–1086
Van Den Boom G, Go PM, Hameeteman W, Dallemagne B, Ament AJ (1996) Cost effectiveness of medical versus surgical treatment in patients with severe or refractory gastro-oesophageal reflux disease in the Netherlands. Scand J Gastroenterol 31:1–9
Viljakka M, Nevalainen J, Isolauri J (1997) Lifetime costs of surgical versus medical treatment of severe gastro-oesophageal reflux disease in Finland. Scand J Gastroenterol 32:766–772
Dire CA, Jones MP, Rulyak SJ, Kahrilas PJ (2003) The economics of laparoscopic Nissen fundoplication. Clin Gastroenterol Hepatol 1:328–332
Nessen SC, Holcomb J, Tonkinson B, Hetz SP, Schreiber MA (1999) Early laparoscopic Nissen fundoplication for recurrent reflux esophagitis: a cost-effective alternative to omeprazole. JSLS 3:103–106
Cookson R, Flood C, Koo B, Mahon D, Rhodes M (2005) Short-term cost effectiveness and long-term cost analysis comparing laparoscopic Nissen fundoplication with proton-pump inhibitor maintenance for gastro-oesophageal reflux disease. Br J Surg 92:700–706
Strate U, Emmermann A, Fibbe C, Layer P, Zornig C (2008) Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc 22:21–30
Disclosures
Drs. A. S. Thijssen, I. A. M. J. Broeders, G. A. de Wit, and W. A. Draaisma have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Thijssen, A.S., Broeders, I.A.M.J., de Wit, G.A. et al. Cost-effectiveness of proton pump inhibitors versus laparoscopic Nissen fundoplication for patients with gastroesophageal reflux disease: a systematic review of the literature. Surg Endosc 25, 3127–3134 (2011). https://doi.org/10.1007/s00464-011-1689-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1689-y