OBJECTIVES: The mainstays of treating gastroesophageal reflux disease (GERD) are medical management and antireflux surgery. The vast amount of research reviews on the effects of clinical treatment stands in stark contrast to the modest economic evidence for each approach. This systematic review aims to provide insights on the direct and indirect costs associated with GERD treatment by analyzing the existing evidence.

METHODS: MEDLINE, Embase and the Cochrane Library were searched for full-text economic evaluations, costs studies, trials and observational studies published in English from 2013 to 2023. Eligible studies included cost data for different medical and surgical options used to manage adults with GERD. Data analysis contained a narrative synthesis.

RESULTS: Seventeen eligible studies were included, of which five were economic evaluations utilizing a Markov model. Most studies reported treatment costs in US dollars (n=9) and had a healthcare perspective (n=12). The time horizon ranged between index admission and lifetime management, and most costs were from the year 2013 (n=4). All studies reported total direct costs, whereas two studies reported total indirect costs. Most studies reported treatment costs for proton pump inhibitors (n=10) or laparoscopic Nissen fundoplication (n=7). In 2013, the total direct cost of medicine was USD $11,587 over 30 years, whereas the total direct cost of surgery was USD $48,491 at index admission and USD $24,143 over 30 years. In general, the specific cost items included in- and outpatient visits, drugs, operating services, and additional procedures such as endoscopy. The indirect costs referred to transportation, absenteeism, and productivity loss. The heterogenous nature of the cost data prevented the possibility to pool data.

CONCLUSIONS: Treating GERD is inevitably associated with costs, which the present review showcases. The heterogeneity of studies investigating direct and indirect costs emphasize the need to assess each treatment method within the relevant context.