With publication of a follow-up report on the Department of Veterans
Affairs cooperative trial comparing long-term outcomes of medical and surgical
therapy for gastroesophageal reflux disease (GERD) by Spechler et al in this
issue of THE JOURNAL,1 it is clear that the
decision to pursue antireflux surgery has not gotten any simpler. The status
of the medical and surgical cohorts is reported 10 to 13 years after initial
enrollment in the trial making this report the most complete, longest-term,
and most carefully collected data available. By all standards, these patients
had severe GERD, evident by the high proportion who had esophageal ulcers,
strictures, or Barrett esophagus at baseline. Common wisdom argues that this
is the group most likely to benefit from antireflux surgery: surgical correction
is long-lasting, replaces antisecretory medications, and eliminates the subsequent
cancer risk—or so the argument goes.
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Figure 22.1-2. Cost-effectiveness Plane and Sensitivity Analysis on Price of H2RAs
Figure 22.1-3. Probabilistic Sensitivity Analysis and Cost-effectiveness Acceptability Curves...
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