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. 2022 Jul 15;10(7):E923-E932.
doi: 10.1055/a-1783-9378. eCollection 2022 Jul.

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

Thomas R McCarty  1   2 , Pichamol Jirapinyo  1   2 , Lyndon P James  3   4 , Sanchit Gupta  1   2 , Walter W Chan  1   2 , Christopher C Thompson  1   2
Affiliations

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

Thomas R McCarty et al. Endosc Int Open. .

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.

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Conflict of interest statement

Competing interests Thomas R. McCarty has no conflicts to disclose. Pichamol Jirapinyo has the following disclosures: Apollo Endosurgery – Research Support, Fractyl – Research Support, GI Dynamics – Research Support, Endogastric Solutions – Consultant. Lyndon P. James has no conflicts to disclose. Sanchit Gupta has no conflicts to disclose. Walter W. Chan has the following disclosures: Ironwood – scientific advisory board. Christopher C. Thompson has the following disclosures: Apollo Endosurgery – Consultant/Research Support (Consulting fees/Institutional Research Grants), Aspire Bariatrics – Research Support (Institutional Research Grant), BlueFlame Healthcare Venture Fund – General Partner, Boston Scientific – Consultant (Consulting fees), Covidien/Medtronic – Consultant (Consulting Fees), EnVision Endoscopy (Board Member), Fractyl – Consultant/Advisory Board Member (Consulting Fees), GI Dynamics – Consultant (Consulting Fees)/ Research Support (Institutional Research Grant), GI Windows – Ownership interest, Olympus/Spiration – Consultant (Consulting Fees)/Research Support (Equipment Loans), Spatz – Research Support (Institutional Research Grant), USGI Medical – Consultant (Consulting Fees)/Advisory Board Member (Consulting fees)/Research Support (Research Grant).

Figures

Fig. 1
Fig. 1
Markov state-transition diagram to evaluate the cost-effectiveness of PPI versus TIF 2.0 versus LNF for the treatment of refractory GERD.
Fig. 2
Fig. 2
Cost-effectiveness plane comparing PPI versus TIF 2.0 versus LNF for refractory GERD at a willingness-to-pay threshold of $ 100,000 per QALY gained.
Fig. 3
Fig. 3
Cost-effectiveness scatterplot of probabilistic sensitivity analysis demonstrating the distribution of costs versus QALYs based on model parameter uncertainties.
Fig. 4
Fig. 4
Cost-effectiveness acceptability curve comparing PPI versus TIF 2.0 versus LNF for refractory GERD at a willingness-to-pay threshold of $ 100,000.
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