DG4: DISEASE SEVERITY DETERMINES COST OF GASTROESOPHAGEAL REFLUX DISEASE IN A MIDWEST USA HEALTH CARE PLAN

Abstract

OBJECTIVES: The primary objective was to describe the cost of illness of gastroesophageal reflux disease (GERD) in a managed care population. Secondary objectives were to characterize GERD costs and to quantify the dependence of costs on disease severity. METHODS: This retrospective study utilized claims data from a large (1.4 million lives) Midwest USA health care plan. Study population had complete medical and pharmacy coverage continuously from 1996 to 1998 and possessed at least one medical claim for GERD. Claim costs were compiled for all GERD-attributable medical and drug claims. Costs were also categorized by health care sector, such as hospital inpatient or pharmacy. ICD-9 codes were used to categorize subjects' GERD into four progressively worse states plus a non-symptomatic state: GERD0 {no GERD claims}, GERD1 {mild esophagitis}, GERD2 {reflux esophagitis}, GERD3 {esophageal ulceration}, and GERD4 {strictures and complications}. RESULTS: A total of 7575 subjects meeting the inclusion and exclusion criteria were identified. The median age was 50 and there were 50% females. Over the three year study period, more than $23 million was spent on GERD-related claims, or $86 per subject per month. Pharmacotherapy contributed 31% of GERD health care costs, inpatient hospital charges 37%, outpatient facility charges 26%, and doctor office charges 6%. Mean cost per month was highly dependent on GERD disease state: GERD0 cost $38 per month, GERD1 was $189, GERD2 was $232, GERD3 was $536, and GERD4 was $412. At higher GERD states, pharmacotherapy was a lower contributor to cost. CONCLUSIONS: For payers of health care, GERD is an expensive disorder to manage. Overall costs associated with GERD increase with the severity of the disease, although the relative contribution of each health care cost sector changes with disease severity.