title: Variation of health-care resource utilization according to GERD-associated complications.
abstract: Complications associated with gastroesophageal reflux disease (GERD) can include esophageal stricture, Barrett's esophagus, gastrointestinal hemorrhage, and extraesophageal symptoms. The impact of GERD-associated complications on health-care utilization deserves further evaluation. We identified commercial enrollees 18-75 years old with claims for GERD (International Classification of Diseases, Ninth Revision, Clinical Modification Codes: 530.81 or 530.11) and subsequent usage of proton pump inhibitors from 01/01/05 to 06/30/09. The initial GERD diagnosis date was designated as the index date, and patients were studied for 6 months preindex and postindex. Eligible patients were subsequently stratified based on medical claims for GERD-associated complications as follows: stage A (GERD diagnosis, no other symptoms), stage B (GERD + extraesophageal symptoms), stage C (GERD + Barrett's esophagus), stage D (GERD + esophageal stricture), and stage E (GERD + iron-deficiency anemia or acute upper gastrointestinal hemorrhage). Patient characteristics, health-care utilization, and costs were compared between stage A and each stage with complicated GERD (B-D). Of the 174,597 patients who were eligible for analysis, 74% were classified as stage A, 20% stage B, 1% stage C, 2% stage D, and 3% stage E. Relative to stage A, patients in stages C, D, and E were significantly more likely to visit a gastroenterologist (13% vs. 68%, 71%, and 38%, respectively) and had higher rates of esophageal ulcers (0.3% vs. 8%, 5%, and 3%, respectively) and Nissen fundoplication (0.05% vs. 0.6%, 0.3%, and 0.2%, respectively). Six-month GERD-related costs ranged from $615/patient (stage A) to $1714/patient (stage D); all-cause costs ranged from $4195/patient (stage A) to $11,340/patient (stage E). Compared with stage A, all other cohorts had significantly higher all-cause and GERD-related costs (P < 0.0001 for all comparisons). While patients with more severe GERD represented a relatively small portion of the GERD cohort, they demonstrated significantly greater health-care costs and overall utilization than patients with uncomplicated GERD.
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California 94063, USA. lgersonmd@yahoo.com
authors.forename: L B
authors.initials: LB
authors.lastname: Gerson
authors.forename: T
authors.initials: T
authors.lastname: McLaughlin
authors.forename: S
authors.initials: S
authors.lastname: Balu
authors.forename: J
authors.initials: J
authors.lastname: Jackson
authors.forename: O
authors.initials: O
authors.lastname: Lunacsek
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000191:economics / Q000209:etiology; D001249:Asthma / Q000191:economics / Q000209:etiology; D001471:Barrett Esophagus / Q000175:diagnosis / Q000191:economics / Q000209:etiology; D001706:Biopsy / Q000706:statistics & numerical data; D003371:Cough / Q000191:economics / Q000209:etiology; D016208:Databases, Factual; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000191:economics / Q000209:etiology; D004945:Esophagoscopy / Q000706:statistics & numerical data; D005260:Female; D018662:Fundoplication / Q000706:statistics & numerical data; D005762:Gastroenterology / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000191:economics*; D006471:Gastrointestinal Hemorrhage / Q000191:economics / Q000209:etiology*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006685:Hoarseness / Q000191:economics / Q000209:etiology; D006801:Humans; D038801:International Classification of Diseases; D007827:Laryngitis / Q000191:economics / Q000209:etiology; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D014456:Ulcer / Q000209:etiology
chemical_list: D054328:Proton Pump Inhibitors