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

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, e...

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Autores principales: McCarty, Thomas R., Jirapinyo, Pichamol, James, Lyndon P., Gupta, Sanchit, Chan, Walter W., Thompson, Christopher C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2022
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9286770/
https://www.ncbi.nlm.nih.gov/pubmed/35845021
http://dx.doi.org/10.1055/a-1783-9378
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author McCarty, Thomas R.
Jirapinyo, Pichamol
James, Lyndon P.
Gupta, Sanchit
Chan, Walter W.
Thompson, Christopher C.
author_facet McCarty, Thomas R.
Jirapinyo, Pichamol
James, Lyndon P.
Gupta, Sanchit
Chan, Walter W.
Thompson, Christopher C.
author_sort McCarty, Thomas R.
collection PubMed
description 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.
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spelling pubmed-92867702022-07-16 Transoral incisionless fundoplication is cost-effective for treatment of gastroesophageal reflux disease McCarty, Thomas R. Jirapinyo, Pichamol James, Lyndon P. Gupta, Sanchit Chan, Walter W. Thompson, Christopher C. Endosc Int Open 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. Georg Thieme Verlag KG 2022-07-15 /pmc/articles/PMC9286770/ /pubmed/35845021 http://dx.doi.org/10.1055/a-1783-9378 Text en 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/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle McCarty, Thomas R.
Jirapinyo, Pichamol
James, Lyndon P.
Gupta, Sanchit
Chan, Walter W.
Thompson, Christopher C.
Transoral incisionless fundoplication is cost-effective for treatment of gastroesophageal reflux disease
title Transoral incisionless fundoplication is cost-effective for treatment of gastroesophageal reflux disease
title_full Transoral incisionless fundoplication is cost-effective for treatment of gastroesophageal reflux disease
title_fullStr Transoral incisionless fundoplication is cost-effective for treatment of gastroesophageal reflux disease
title_full_unstemmed Transoral incisionless fundoplication is cost-effective for treatment of gastroesophageal reflux disease
title_short Transoral incisionless fundoplication is cost-effective for treatment of gastroesophageal reflux disease
title_sort transoral incisionless fundoplication is cost-effective for treatment of gastroesophageal reflux disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9286770/
https://www.ncbi.nlm.nih.gov/pubmed/35845021
http://dx.doi.org/10.1055/a-1783-9378
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