J Neurogastroenterol Motil  https://doi.org/10.5056/jnm19050
Treatment pattern and economic burden of refractory GERD patients in South Korea
Susan Park1, Jin-Won Kwon1, Joong-Min Park2, Sungsoo Park3, and Kyung Won Seo4*
1College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea; 2Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea; 3Department of Surgery, Korea University College of Medicine, Seoul, Korea; and 4Department of Surgery, Kosin University College of Medicine, Busan, Korea
Correspondence to: Kyung Won Seo, MD, PhD
Department of Surgery, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea
Tel: +82-51-990-6782, Fax: +82-51-246-6093, E-mail: kwseo@kosin.ac.kr
Susan Park and Jin-Won Kwon equally contributed to this study.
Received: March 12, 2019; Revised: June 12, 2019; Accepted: July 20, 2019; Published online: November 5, 2019.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
The prevalence of gastroesophageal reflux disease (GERD) has increased in Korea, and the economic burden of this chronic disease is substantial. We aim to investigate the treatment pattern and economic burden in Korea of refractory GERD requiring long-term use of proton pump inhibitors (PPIs).
Methods
We conducted a cross-sectional analysis of nationally representative sample data obtained from 2012 to 2016 and provided by the Health Insurance Review and Assessment Service. The participants were 86 936 in the medication group and 40 in the surgery group. Age- and sex-standardized prevalence of refractory GERD requiring PPIs medication for more than 12 weeks were analyzed. Generalized linear models were used to estimate cost ratios for comparing the medical costs of the surgery and medication groups after adjustment for demographics and comorbidity.
Results
The prevalence of refractory GERD increased from 1.2% in 2012 to 1.9% in 2016, and the estimated total number of GERD patients increased from 402 000 to 736 000 during this time period. The medical expenditures of the surgery group within 90 days of antireflux surgery (ARS) were 16.9-fold higher compared to those of the medication group; the significant difference in medical costs between the 2 groups disappeared after 90 days post-surgery.
Conclusions
The prevalence of refractory GERD requiring long-term use of PPIs has been trending upwards recently. Nevertheless, ARS is very rarely performed. Considering the increasing medical costs of long-term PPI use, further cost-effectiveness analysis is needed to compare ARS and PPI therapy for the treatment of GERD in Korea.
Keywords: Fundoplication; Gastroesophageal reflux; Proton pump inhibitors


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