Costs of acid-related disorders to a health maintenance organization

Am J Med. 1997 Dec;103(6):520-8. doi: 10.1016/s0002-9343(97)00308-2.


Background: Little is known about the economic impact of the acid-related disorders (ARDs), which include dyspepsia, gastritis, gastroesophageal reflux disease (GERD), and peptic ulcer disease (PUD), in managed care patient populations.

Objectives: To describe the prevalence of medically attended ARDs, and their direct medical costs from the perspective of a large health maintenance organization (HMO).

Methods: A total of 1,550 ARDs subjects (age > or = 18 years), were randomly sampled from outpatient diagnosis and pharmacy databases of the Kaiser Permanente Medical Care Program of Northern California and verified by chart review. Five age- and gender-matched controls were identified per subject. One-year prevalence, excess annual costs, and initial 6-month costs for incident cases were estimated using the HMO cost accounting system.

Results: Total ARDs prevalence (5.8%) increases with advancing age. GERD is the most common ARD (2.9% overall prevalence). Annual per person attributable costs were $1,183, $471, and $431 respectively for PUD, GERD, and gastritis/dyspepsia. Excess inpatient costs for PUD explain its higher costs. Outpatient costs were somewhat higher for GERD ($279) than for PUD or gastritis/dyspepsia. Pharmacy costs were relatively low for each condition, in part because many patients were treated with generic cimetidine. Total annual HMO expenditures for ARDs were $59.4 million, with 40.6%, 36.8%, and 22.6% respectively for GERD, PUD, and gastritis/dyspepsia.

Conclusions: Acid-related disorders, particularly GERD and PUD, contribute substantially to the direct costs of medical care in this managed care population.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • California
  • Dyspepsia / economics*
  • Female
  • Gastritis / economics*
  • Gastroesophageal Reflux / economics*
  • Health Care Costs*
  • Health Maintenance Organizations / economics*
  • Humans
  • Male
  • Middle Aged
  • Peptic Ulcer / economics*