OBJECTIVES: Gastroesophageal reflux disease (GERD) is one of most prevalent conditions in Western societies, characterized by heartburn, chest pain, and regurgitation. Proton pump inhibitor (PPI)-based medical management is the standard treatment for GERD in Switzerland, but surgical options like Nissen fundoplication and LINX system are considered when medical therapy fails. The RefluxStop procedure, with a silicon implant in a fundic pocket, offers an alternative solution. This study aims to evaluate the cost-effectiveness of RefluxStop compared to existing surgical treatments and PPIs.

METHODS: To evaluate the cost-effectiveness of RefluxStop, a Markov model was developed based on a recently published economic model manuscript. The model considered the perspective of Swiss healthcare payers, with a lifetime horizon, one-month cycle length, and 3% annual discount rate for costs and benefits. Health states were included relevant for the illness that patients experience during the disease course. Treatment-specific adverse events were incorporated, and benefits were measured in quality-adjusted life-years (QALYs). Unit costs were derived from Swiss diagnostic-related group databases and published literature. Clinical efficacy data for RefluxStop came from its CE mark study, and comparator treatments were based on published literature. Uncertainty was explored through deterministic and probabilistic sensitivity analyses.

RESULTS: RefluxStop provided higher QALYs at lower costs compared to Nissen fundoplication and the LINX system. In comparison to PPIs, the incremental cost-effectiveness ratio (ICER) for RefluxStop was CHF 2,116. At a cost-effectiveness threshold of CHF 100,000 per QALY gained, RefluxStop had a high probability of being cost-effective, with probabilities of 100%, 97%, and 100% against PPIs, Nissen fundoplication, and the LINX system, respectively. Both deterministic and probabilistic sensitivity analyses provided robustness to the analysis. In a scenario analysis of a 10-year time horizon, RefluxStop was still cost-effective compared to other options.

CONCLUSIONS: The RefluxStop procedure is highly likely to be a cost-effective treatment for GERD.