COSTS OF ACID-RELATED DISORDERS TO A HEALTH MAINTENANCE ORGANIZATION

BACKGROUND: Little is known about the economic impact of the acid-rela ted disorders (ARDs), which include dyspepsia, gastritis, gastroesopha geal reflux disease (GERD), and peptic ulcer disease (PUD), in managed care patient populations. OBJECTIVES: TO describe the prevalence of m edically attended ARDs, and their direct medical costs from the perspe ctive of a large health maintenance organization (HMO). METHODS: A tot al of 1,550 ARDs subjects (age greater than or equal to 18 years), wer e 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 i dentified per subject. One-year prevalence, excess annual costs, and i nitial 6-month costs for incident cases were estimated using the HMO c ost accounting system. RESULTS: Total ARDs prevalence (5.8%) increases with advancing age. GERD is the most common ARD (2.9% overall prevale nce). 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 somewha t higher for GERD ($279) than for PUD or gastritis/dyspepsia. Pharmacy costs were relatively low for each condition, in part because many pa tients were treated with generic cimetidine. Total annual HMO expendit ures for ARDs were $59.4 million, with 40.6%, 36.8%, and 22.6% respect ively for GERD, PUD, and gastritis/dyspepsia. CONCLUSIONS: Acid-relate d disorders, particularly GERD and PUD, contribute substantially to th e direct costs of medical care in this managed care population. (C) 19 97 by Excerpta Medica, Inc.