title: Costs of acid-related disorders to a health maintenance organization.
abstract: BACKGROUND
  Little is known about the economic impact of the acid-related disorders (ARDs), which include dyspepsia, gastritis, gastroesophageal reflux disease (GERD), and peptic ulcer disease (PUD), in managed care patient populations.
  
  
  OBJECTIVE
  To describe the prevalence of medically attended ARDs, and their direct medical costs from the perspective of a large health maintenance organization (HMO).
  
  
  METHODS
  A total of 1,550 ARDs subjects (age > or = 18 years), were randomly sampled from outpatient diagnosis and pharmacy databases of the Kaiser Permanente Medical Care Program of Northern California and verified by chart review. Five age- and gender-matched controls were identified per subject. One-year prevalence, excess annual costs, and initial 6-month costs for incident cases were estimated using the HMO cost accounting system.
  
  
  RESULTS
  Total ARDs prevalence (5.8%) increases with advancing age. GERD is the most common ARD (2.9% overall prevalence). Annual per person attributable costs were $1,183, $471, and $431 respectively for PUD, GERD, and gastritis/dyspepsia. Excess inpatient costs for PUD explain its higher costs. Outpatient costs were somewhat higher for GERD ($279) than for PUD or gastritis/dyspepsia. Pharmacy costs were relatively low for each condition, in part because many patients were treated with generic cimetidine. Total annual HMO expenditures for ARDs were $59.4 million, with 40.6%, 36.8%, and 22.6% respectively for GERD, PUD, and gastritis/dyspepsia.
  
  
  CONCLUSIONS
  Acid-related disorders, particularly GERD and PUD, contribute substantially to the direct costs of medical care in this managed care population.
authors.affiliation: Division of Gastroenterology, University of California, San Francisco, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Levin
authors.forename: J A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: K
authors.initials: K
authors.lastname: Kunz
authors.forename: J M
authors.initials: JM
authors.lastname: Henning
authors.forename: C J
authors.initials: CJ
authors.lastname: Henke
authors.forename: C J
authors.initials: CJ
authors.lastname: Colby
authors.forename: J V
authors.initials: JV
authors.lastname: Selby
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D004415:Dyspepsia / Q000191:economics*; D005260:Female; D005756:Gastritis / Q000191:economics*; D005764:Gastroesophageal Reflux / Q000191:economics*; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000191:economics*