The economics of laparoscopic Nissen fundoplication.

BACKGROUND & AIMS: A major impetus for laparoscopic Nissen fundoplication (LNF) is its purported cost savings compared with medical therapy, but few studies have examined these economic outcomes. The aim was to analyze health care costs and use among a cohort of patients undergoing LNF and compare them with patients with medically treated gastroesophageal reflux disease (GERD). METHODS: Comparison of health care use and direct costs from the third-party payer perspective using 13 United HealthCare Plans. Sixty-one patients who underwent LNF from January 1994 to June 1998 and 178 matched controls were used for this study. Outcome variables included the cost of hospital and outpatient visits, hospitalizations, related endoscopic procedures, and pharmacy claims for proton pump inhibitors, H(2) receptor antagonists, and prokinetics. Cost of LNF or index esophagogastroduodenoscopy was not included. RESULTS: Sixty-one LNF patients and 178 controls were studied. No differences were seen for the costs of office visits and hospital admissions or the number of gastrointestinal procedures. LNF patients had significantly lower gastrointestinal medication costs. Median total health care costs were significantly lower in the LNF group but mean total costs were not different. This was attributable to $201,000 in costs for managing complications in one patient that skewed total health care cost in the LNF group. CONCLUSIONS: For the 12 months after surgery, LNF reduced costs for gastrointestinal medications but not total costs for the cohort. LNF cost is impacted greatly by the cost of associated complications. Based on these data, LNF does not appear to significantly reduce the direct cost of health care for GERD patients on a population basis.