Health care utilization after medical and surgical therapy for gastroesophageal reflux disease - A population-based study, 1996 to 2000

Hypothesis: Patients who undergo surgical treatment for gastroesophageal reflux disease (GERD) will use fewer health care resources than those who continue to be treated medically during the same follow-up period. Design: Matched cohort study of patients with a diagnosis of GERD receiving surgical therapy or medical therapy. Setting: Tennessee Medicaid (TennCare) program from 1996 through 2000. Patients: Population-based sample of 7635 TennCare enrollees with a diagnosis of GERD served as the underlying population. Of these, 111 surgical patients who under-went fundoplication in 1996 met inclusion criteria. The 200 patients in the medically treated cohort were randomly matched to patients in the surgical cohort by demographic characteristics and previous use of acid-suppressing drugs. Interventions: The surgical group all under-went fundoplication in 1996. The medical group was treated without fundoplication. Main Outcome Measures: Health care utilization (medication use, outpatient visits, hospitalizations, and diagnostic studies) for each cohort through December 2000. Results: In the 4-year follow-up period, the surgical group had fewer GERD-related outpatient physician visits (5.5 +/- 6.9 visits vs 6.7 +/- 6.1 visits; P=.10). Utilization of other types of outpatient and inpatient care was similar. During each year of follow-up, the proportion of persons using GERD medication was lower in the surgical group. (0.67 vs 0.93 in year 1, 0.67 vs 0.91 in year 2, 0.72 vs 0.85 in year 3, and 0.74 vs 0.90 in year 4). Conclusion: The utilization of health care resources in patients treated surgically for GERD is associated with a modest decrease in the use of GERD-related medications and GERD-related visits.