Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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.
See this image and copyright information in PMC

References

    1. Zagari R M, Fuccio L, Wallander M A et al.Gastro-oesophageal reflux symptoms, oesophagitis and Barrettʼs oesophagus in the general population: the Loiano-Monghidoro study. Gut. 2008;57:1354–1359. - PubMed
    1. Camilleri M, Dubois D, Coulie B et al.Prevalence and socioeconomic impact of upper gastrointestinal disorders in the United States: results of the US Upper Gastrointestinal Study. Clin Gastroenterol Hepatol. 2005;3:543–552. - PubMed
    1. Flook N, Jones R, Vakil N. Approach to gastroesophageal reflux disease in primary care: Putting the Montreal definition into practice. Can Fam Physician. 2008;54:701–705. - PMC - PubMed
    1. Pace F, Bazzoli F, Fiocca R et al.The Italian validation of the Montreal Global definition and classification of gastroesophageal reflux disease. Eur J Gastroenterol Hepatol. 2009;21:394–408. - PubMed
    1. Vakil N, van Zanten S V, Kahrilas P.The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus Am J Gastroenterol 20061011900–1920.; quiz 43 - PubMed