Anti-reflux surgery versus proton pump inhibitors for severe gastroesophageal reflux disease: A cost-effectiveness study in Korea

Susan Park, Sungsoo Park, Joong Min Park, Soorack Ryu, Jinseub Hwang, Jin Won Kwon, Kyung Won Seo

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background/Aims The economic burden for gastroesophageal reflux disease (GERD) has recently increased in Asian countries. This study investigates the cost-effectiveness between anti-reflux surgery and medication, with proton pump inhibitors (PPIs) for GERD in Korea. Methods We used a decision tree and Markov model to obtain the costs and quality-adjusted life years (QALYs) of the surgical and medical strategies. Our target cohort was the severe GERD patients aged 50 years old who required a continuous double dose of PPIs. The time horizon was 10 years and all estimates were discounted at 5% per year. The incremental cost-effectiveness ratio of the anti-reflux surgery compared with medication with PPIs was calculated. Sensitivity analyses were performed on all relevant variables. Results The cost-utility analysis indicated anti-reflux surgery was more cost-effective than medication among severe GERD patients over a 10-year period. The model predicted that the surgical strategy had a cost savings of $551 and the QALYs had a gain of 1.18 as compared with the medical strategy. The break-even point in costs of the anti-reflux surgery over the medication was estimated to be 9 years. Sensitivity analyses using the varying parameter assumptions demonstrated the robustness of the study results. Conclusions This study showed anti-reflux surgery was less expensive and more effective therapy over the PPI medication after 9 years of follow-up. This suggests the surgical strategy is a cost-effective alternative to PPI medication among patients who need long-term management for GERD in Korea.

Original languageEnglish
Pages (from-to)215-223
Number of pages9
JournalJournal of Neurogastroenterology and Motility
Issue number2
StatePublished - 1 Apr 2020


  • Cost of illness
  • Gastroesophageal reflux disease
  • Proton pump inhibitors
  • Quality-adjusted life years


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