Objective:

This study assessed the economic burden of refractory gastroesophageal reflux disease (GERD) among employer-sponsored insurance holders in a large multi-employer claims database in the US.

Methods:

This retrospective observational study evaluated GERD costs in a multi-employer claims database from Gallagher, between January 1, 2019 and June 30, 2020. The study population was patients aged 18-65 years with a diagnosis for GERD and continuous enrollment in employer-sponsored health plans. Annual medical costs and pharmacy costs (excluding over-the-counter medications) were evaluated for all GERD patients and for the subset who received acid reflux surgery.

Results:

A total of 145,656 patients with GERD (12.2%) were identified out of 1,193,097 patients in the database; 57,783 patients (44.3%) took prescription proton pump inhibitors (PPIs), and 646 patients (0.5%) received anti-reflux surgery. The cost burden of GERD was substantial. GERD patients had a total of $13,331 annual paid claims per person (SD=$26,600). Overall mean (SD) annual healthcare cost was higher for patients with surgery compared to patients without surgery (non-surgery $13,194 [$25,703] vs. surgery $40772 [$99,073], p<.0001). Overall mean (SD) annual pharmacy cost was lower for patients with surgery compared to patients without surgery (surgical cohort $3,136 [$8,981] vs. non-surgical cohort $2,855 [$4,630], p<.0001). Among patients with surgery, overall cost per day and reimbursement were higher within 90-day window post- vs. pre-surgery (post-surgery $379 [$724] vs. pre-surgery $114 [$309], p<.0001). The pharmacy cost per-day (SD) greater than 90 days post-surgery was lower than non-surgical cohort (greater than 90 days post-surgery $5 [$17] vs. non-surgical cohort $7 [$32], p<.0001).

Conclusions:

This large U.S. retrospective database study demonstrated the substantial cost burden of GERD. Overall medical and pharmacy reimbursement were higher among patients who received surgery; however, analyses did not account for potential confounders or longer term benefits of surgery.