Ann Surg Treat Res.  2020 May;98(5):254-261. 10.4174/astr.2020.98.5.254.

The characteristics of antireflux surgery compared to proton pump inhibitor treatment in Korea: a nationwide study using claim data from 2007 to 2016

• Park S
• Kwon JW
• Park JM
• Park S
• Hwang J
• Seo KW

• KMID: 2500826
• DOI: http://doi.org/10.4174/astr.2020.98.5.254

Abstract

Purpose
Laparoscopic antireflux surgery is not widely used in Korea, but published data suggest that its results are comparable to those of Western countries. The purpose of this study was to compare the clinical characteristics, medical utilization, and medical costs of antireflux surgery and proton pump inhibitor (PPI) treatments.
Methods
We used Korean patients who underwent fundoplication (n = 342, surgery group) and a 25% random sample of all patients diagnosed with gastroesophageal reflux disease (GERD) who were prescribed PPIs for more than 12 weeks (n = 130,987, medication group) between 2007 to 2016. We compared medical costs and utilization between the 2 groups.
Results
The average cost of fundoplication was $4,631. The costs of GERD treatment in the first year after surgery and during the follow-up period were $78.1 and $50.1 per month, respectively. In the surgery group, the average monthly medical expenses decreased as the year progressed, but the average monthly medical expenses ($137.5 per month) did not decrease in the medication group. After stratifying by age group, the medical costs of the surgery group were lower than those of the medication group for all ages except for patients between the ages of 70 and 79. The cost difference between the 2 groups was prominent between the ages of 20 and 49.
Conclusion
This study showed that a significant decrease in cost was observed 1 year after surgery, and it was more apparent in younger patients. Further research is needed to determine the appropriateness of antireflux surgery for each group of patients.

Keyword

Costs; Fundoplication; Gastroesophageal reflux disease; Proton pump inhibitor

Figure

• 

  Fig. 1 Patient flow diagram. GERD, gastroesophageal reflux disease; PPI , proton pump inhibitor.

Reference

1. Nissen R. A simple operation for control of ref lux esophagitis. Schweiz Med Wochenschr. 1956; 86:590–592. PMID: 13337262.

2. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc. 1991; 1:138–143. PMID: 1669393.

3. Bojke L, Hornby E, Sculpher M. REFLUX Trial Team. A comparison of the cost effectiveness of pharmacotherapy or surgery (laparoscopic fundoplication) in the treatment of GORD. Pharmacoeconomics. 2007; 25:829–841. PMID: 17887805.

4. Epstein D, Bojke L, Sculpher MJ. REFLUX Trial Group. Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: cost effectiveness study. BMJ. 2009; 339:b2576. PMID: 19654097.

5. Funk LM, Zhang JY, Drosdeck JM, Melvin WS, Walker JP, Perry KA. Long-term cost-effectiveness of medical, endoscopic and surgical management of gastroesophageal reflux disease. Surgery. 2015; 157:126–136. PMID: 25262216.

6. Kim JJ, Jang EJ, Kim DH, Park H, Sohn HS. Proton pump inhibitors' use in Korea based on the National Health Insurance Sample Cohort Database (2002-2013). Yakhak Hoeji. 2018; 62:171–178.

7. Kim KM, Cho YK, Bae SJ, Kim DS, Shim KN, Kim JH, et al. Prevalence of gastroesophageal reflux disease in Korea and associated health-care utilization: a national population-based study. J Gastroenterol Hepatol. 2012; 27:741–745. PMID: 21916988.

8. Rubenstein JH, Chen JW. Epidemiology of gastroesophageal ref lux disease. Gastroenterol Clin North Am. 2014; 43:1–14. PMID: 24503355.

9. Galmiche JP, Hatlebakk J, Attwood S, Ell C, Fiocca R, Eklund S, et al. Laparoscopic antiref lux surgery vs esomeprazole t reatment for chronic GERD: the LOTUS randomized clinical trial. JAMA. 2011; 305:1969–1977. PMID: 21586712.

10. Anvari M, Allen C, Marshall J, Armstrong D, Goeree R, Ungar W, et al. A randomized controlled trial of laparoscopic Nissen fundoplication versus proton pump inhibitors for the treatment of patients with chronic gastroesophageal reflux disease (GERD): 3-year outcomes. Surg Endosc. 2011; 25:2547–2554. PMID: 21512887.

11. Grant AM, Cotton SC, Boachie C, Ramsay CR, Krukowski ZH, Heading RC, et al. Minimal access surgery compared with medical management for gastro-oesophageal reflux disease: five year follow-up of a randomised controlled trial (REFLUX). BMJ. 2013; 346:f1908. PMID: 23599318.

12. Lee JH, Park JM, Han SU, Kim JJ, Song KY, Ryu SW, et al. Antireflux surgery in Korea: a nationwide study from 2011 to 2014. Gut Liver. 2016; 10:726–730. PMID: 27114420.

13. Park JM, Chi KC. Antireflux surgery is equally beneficial in nonerosive and erosive gastroesophageal reflux disease. Ann Surg Treat Res. 2018; 95:94–99. PMID: 30079326.

14. Park S, Park JM, Kim JJ, Lee IS, Han SU, Seo KW, et al. Multicenter prospective study of laparoscopic nissen fundoplication for gastroesophageal reflux disease in Korea. J Neurogastroenterol Motil. 2019; 25:394–402. PMID: 31327221.

15. Park S, Kwon JW, Park JM, Park S, Seo KW. Treatment pattern and economic burden of refractory GERD patients in South Korea. J Neurogastroenterol Motil. 2020; 26:281–288. PMID: 31682754.

16. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005; 43:1130–1139. PMID: 16224307.

17. Korean Statistical Information Service. Consumer Price Index by items [Internet]. Daejeon (Korea): 2020. cited 2019 Nov 20. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1J17001&vw_cd=MT_ZTITLE&list_id=C1_15&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=MT_ZTITLE.

18. Korean Statistical Information Service. Consumer price index, statistical information report [Internet]. Daejeon (Korea): 2020. cited 2019 Dec 24. Available from: http://meta.narastat.kr/metasvc/svc/SvcMetaDcDtaPopup.do?orgId=101&confmNo=101007&kosisYn=Y.

19. Arguedas MR, Heudebert GR, Klapow JC, Centor RM, Eloubeidi MA, Wilcox CM, et al. Re-examination of the cost-effectiveness of surgical versus medical therapy in patients with gastroesophageal reflux disease: the value of long-term data collection. Am J Gastroenterol. 2004; 99:1023–1028. PMID: 15180720.

20. Faria R, Bojke L, Epstein D, Corbacho B, Sculpher M. REFLUX Trial Group. Cost-effectiveness of laparoscopic fundoplication versus continued medical management for the treatment of gastro-oesophageal reflux disease based on long-term follow-up of the REFLUX trial. Br J Surg. 2013; 100:1205–1213. PMID: 23775366.

21. Cookson R, Flood C, Koo B, Mahon D, Rhodes M. 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. 2005; 92:700–706. PMID: 15852426.

22. Mehta S, Bennett J, Mahon D, Rhodes M. Prospective trial of laparoscopic nissen fundoplication versus proton pump inhibitor therapy for gastroesophageal reflux disease: seven-year follow-up. J Gastrointest Surg. 2006; 10:1312–1316. PMID: 17114017.

23. Fock KM, Talley N, Goh KL, Sugano K, Katelaris P, Holtmann G, et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus. Gut. 2016; 65:1402–1415. PMID: 27261337.

24. Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut. 2012; 61:1340–1354. PMID: 22684483.

25. Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD. SAGES Guidelines Committee. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2010; 24:2647–2669. PMID: 20725747.

26. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013; 108:308–328. PMID: 23419381.

27. Fei L, Rossetti G, Moccia F, Marra T, Guadagno P, Docimo L, et al. Is the advanced age a contraindication to GERD laparoscopic surgery? Results of a long term follow-up. BMC Surg. 2013; 13 Suppl 2:S13. PMID: 24267613.

28. Kinoshita Y, Ishimura N, Ishihara S. Advantages and disadvantages of long-term proton pump inhibitor use. J Neurogastroenterol Motil. 2018; 24:182–196. PMID: 29605975.

29. Fibbe C, Layer P, Keller J, Strate U, Emmermann A, Zornig C. Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical, and manometric study. Gastroenterology. 2001; 121:5–14. PMID: 11438489.

30. Maret-Ouda J, Wahlin K, El-Serag HB, Lagergren J. Association between laparoscopic antireflux surgery and recurrence of gastroesophageal reflux. JAMA. 2017; 318:939–946. PMID: 28898377.