OBJECTIVE: To calculate the break-even point as the number of years after Laparoscopic Nissen fundoplication surgery where the surgery’s cost are equivalent to the costs associated with omeprazole maintenance therapy for patients with severe gastroesophageal reflux disease (GERD). METHODS: A Markov decision analytic model was developed to estimate the direct medical costs of each alternative for treating patients with severe GERD. The payer perspective was utilized and a literature review was conducted to identify the direct costs associated with each approach. The probabilities used in the model were estimated from published clinical trials. The Markov model cycle was set equal to one year and the break-even point was identified as the year in which the expected value of the costs of each treatment were equal. Sensitivity analyses were performed. RESULTS: The break-even point of the two therapies is approximately 12 years. By subtracting 12 years from the average US life expectancy, the break-even age is 64 years in which the costs of surgical treatment for persons under the age of 64 is less than omeprazole for the remaining years of life. The results of the sensitivity analyses will be reported. DISCUSSION: This study provides evidence that Laparoscopic Nissen fundoplication becomes a cost saving approach relative to omprezole therapy when omeprazole therapy is expected to last more than 12 years. This model assumes omeprazole therapy is taken continuously over a patient's lifetime to treat severe GERD and assumes that successful surgery does not require maintentance omeprazole and lasts a patient's lifetime. This procedure is a relatively new technique and there is no long-term data on the success rate. The standard prognosis of success for the surgery used by Gastroenterologists has been 10 years. The surgical procedure may not be cost saving if the success rate declines after 10 years.