Utilisation and Expenditures in the Treatment of Patients with Gastro-Oesophageal Reflux Disease: Prevalence and High Cost Factors
Tamra J. Lair
Daniel R. Anderson
Joseph A. Crawley
Objective: Disease management can be described as a data-driven care process across the continuum from symptom perception through to diagnosis and treatment. In order to effectively manage this medical-care process, the practitioner must understand the epidemiology of the disease, and nature of the interaction between the disease, the patients and the healthcare system. With this framework in mind, this research provides a picture of gastro-oesophageal reflux disease (GORD) prevalence, demographics, treatment utilisation patterns and costs in a managed-care environment. Design and Setting: Because GORD is prevalent, affecting up to 10% of the US population, and has high levels of comorbidity and serious complications, even the direct costs of GORD can be significant. Medical and pharmacy claim databases from 4 health maintenance organisations (HMOs) in 1993 and 1994 were used to identify GORD patients. Total health services and drug utilisation, GORD-related medical procedures, concomitant diseases, and associated costs were tallied. Logistic regression models were used to estimate the high cost factors in GORD patients. A health service profile of patients with GORD treated in a managed care setting was also developed in this analysis. Results: While GORD represents a relatively small percentage of managed care spending (9.9%) there was wide variation in utilisation patterns for drugs, laboratory tests and provider types. Drugs accounted for nearly 50% of the total costs of GORD treatment. In addition, comorbid conditions seemed to have a significant impact on the overall spending of GORD patients in this environment. Asthma and chronic obstructive pulmonary disease were predictive of high cost. Conclusions: Variance in costs across managed care plans studied implies that the cost structures and clinical management approaches of the plans may have an impact on the treatment of GORD.
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