Shahin Ayazi, MD, Ali H Zaidi, MD, Kirsten Newhams, MD, Ping Zheng, MD, Yoshihiro Komatsu, MD, Fahim Habib, MD, Tameka Scott, DO, Kristy Chovanec, BS, Jonathan Levy, MD, Toshitaka Hoppo, MD, Blair A Jobe, MD. Esophageal and Lung Institute, Allegheny Health Network
Introduction: Magnetic sphincter augmentation (MSA) is a promising anti-reflux surgical treatment. The cost associated with the device may be perceived as a drawback that may limit the adoption of this technique. There is limited data regarding the cost of MSA in the management of reflux disease. This study compares the procedure cost and the disease-related and overall expense of MSA compared to laparoscopic Nissen fundoplication (LNF).
Methods and Procedures: This prospective observational study was performed in conjunction with the region’s largest health insurance company. Data were collected on patients who underwent MSA over a 2-year period beginning in September 2015 at the study network hospitals. The LNF comparison group was procured from members’ claims data of the payer and included patients who may have not been treated within the study network. Inclusion was predicated by patients having continuous coverage for 24 months. The total procedural cost and the disease-related and overall medical claims submitted 12 months prior to surgery and 12 months following surgery were obtained. The reimbursement data are presented as payments per member per month (PMPM). These values were then compared between groups using Wilcoxon signed-rank test.
Results: There were 180 patients who underwent MSA and 1131 that had LNF. The median (IQR) cost of surgery was $13522 (13195-14439) for those who underwent MSA and $13388 (9951-16261) for patients with LNF, p=0.02. In patients who underwent MSA, the median reimbursement related to the upper gastrointestinal disease was $ 305 PMPM, at 12 months prior to surgery and $ 104 at 12 months after surgery, representing 66% decrease in cost. These values were $ 233 PMPM and $126 PMPM for patients who underwent LNF, representing a 46% decrease The % decrease in PMPM cost was significantly different between MSA and LNF (p=0.0001).
At 12 months following surgery, the reimbursement for overall medical expenses had decreased by 10.7% in the MSA group and only 1.4% in the LNF group when compared to the preoperative baseline reimbursement. The reimbursement for PPI use after surgery showed a 95% decrease in the MSA group and 90% among LNF group when compared to the preoperative baseline.
Conclusion: When compared with LNF, MSA results in a reduction of disease-related and overall medical expense in the year following surgery. MSA is associated with a higher surgical cost when compared to LNF, and this difference is likely offset or surpassed by the reduction in expense after surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94161
Program Number: S021
Presentation Session: Foregut I
Presentation Type: Podium
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