Development of a refractory gastro-oesophageal reflux score using an administrative claims database

Aliment Pharmacol Ther. 2011 Sep;34(5):555-67. doi: 10.1111/j.1365-2036.2011.04755.x. Epub 2011 Jun 30.

Abstract

Background: Approximately one-third of gastro-oesophageal reflux disease (GERD) patients demonstrate refractory symptoms following treatment with proton pump inhibitor (PPI) therapy.

Aim: To develop a refractory GERD score that can be applied to predict patients' healthcare utilisation.

Methods: We enrolled adults (≥18 years) with a diagnosis of GERD. Refractory GERD was evaluated on an 8-point scale where 1 point was given for each of the following criteria: doubling, addition, or switching of GERD medication dose, receipt of a GERD-related endoscopic procedure or surgery, or ≥3 GERD-related outpatient visits. Refractory GERD was defined as the presence of two or more points.

Results: A total of 135,139 GERD patients (44% male) were analysed with a mean (±s.d.) age of 52.9 ± 15 years. The mean overall refractory GERD score was 1.12 ± 1.2 (range 0-8 on an 8-point scale); 31% of patients had refractory GERD with a mean score of 2.56 ± 0.82. Among patients with refractory GERD, 31% doubled their GERD medication, 28% added a new GERD medication, 60% switched GERD medications, 54% had a GERD-related procedure and 1% had a GERD-related surgery. Patients with refractory GERD were more likely to be female (59% vs. 55%, P < 0.001) and had a higher co-morbidity score (0.78 vs. 0.56, P < 0.001). The overall mean costs for refractory patients during the study period were significantly higher compared with treatment-responsive patients ($18,088 ± $36,220 vs. $11,044 ± $22,955, P < 0.001).

Conclusions: Refractory GERD was present in approximately one-third of the GERD patients. We created a GERD refractory score that could define need for increased anti-reflux therapy and predict higher healthcare resource utilisation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Databases, Factual
  • Drug Resistance
  • Female
  • Gastroesophageal Reflux / drug therapy*
  • Gastroesophageal Reflux / economics
  • Gastroesophageal Reflux / physiopathology
  • Health Care Costs
  • Humans
  • Male
  • Medicare
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Proton Pump Inhibitors / economics
  • Proton Pump Inhibitors / therapeutic use*
  • Retrospective Studies
  • Severity of Illness Index*
  • Treatment Outcome
  • United States
  • Young Adult

Substances

  • Proton Pump Inhibitors