title: Gastro-oesophageal acid-related disease, co-morbidity and medical care cost.
abstract: OBJECTIVE
  To analyse the incremental medical care cost of gastro-oesophageal acid-related disease (GERD), and its interactive effects with other diagnoses.
  
  
  METHODS
  A retrospective cohort study was conducted. Six hundred GERD patients were randomly selected and 600 non-GERD patients were selected, matched by age, gender, prescription pharmaceutical benefits and insurance status. Information on demographics, direct medical care cost (DMC) (inpatient, ambulatory and pharmaceuticals) and health service utilization was obtained from a large, not-for-profit managed-care organization across 3 years (1996-1998). DMCs were compared between GERD and non-GERD groups using the bootstrap method. Random coefficient log linear regression models were used to analyse incremental cost and assess its association with other diagnoses.
  
  
  RESULTS
  The mean annual DMC for the GERD group was $4906, as compared to $2054 for the non-GERD group. The increase in the DMC in the GERD group was attributable to increased co-morbidity. Age and gender had no effect on total cost for the GERD population. Among costs of services, the GERD group had a 2.00-fold higher cost associated with outpatient services, a 1.70-fold higher cost associated with inpatient services, and a 2.70-fold higher cost associated with pharmacy.
  
  
  CONCLUSIONS
  GERD is a chronic disease often associated with other diagnoses that significantly affect total DMC. Although the direct cost of treating GERD is low, patients with GERD had significantly higher total medical care cost than those without GERD. The addition of one more disease to a person's existing group of diseases has an important long-term health cost impact.
authors.affiliation: Division of Geriatrics, Department of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104-2676, USA. jravi@mail.med.upenn.edu
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Jayadevappa
authors.forename: Sumedha
authors.initials: S
authors.lastname: Chhatre
authors.forename: Mark
authors.initials: M
authors.lastname: Weiner
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000191:economics* / Q000628:therapy; D017048:Health Care Costs; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data