Annals of bad study conclusions

BBC NEWS | Health | Surgery beneficial in heartburn

A year after keyhole surgery, only 14% of patients were still taking medication, compared with 90% of those treated with drugs alone.

The £1m trial of 800 patients suggests surgery should be done more routinely in patients with chronic acid reflux.

The results so far suggest the procedure, although expensive at £2000 per patient, is cost-effective because reflux sufferers no longer have to take medication and their quality of life improves.

But they are following the patients for five years to check the benefits are long-term.

Professor Roger Jones, head of general practice at King’s College London and chair of the Primary Care Gastroenterology Society said surgery was often regarded as “too extreme” for something which is not a serious problem.

“But for some people, it is a serious problem which could potentially mean a lifetime of tablet taking.”

Let’s review: the operation costs $4000, plus recovery time, plus risk of complications. For this, we get only 14% of patients still taking acid blockers at the end of a year. Those same pills cost 50 cents to a a dollar a day, and 90% of patients will be taking those at the end of a year.

So for the first year our expected costs for a thousand patients treated with surgery are about $4,040,000. For a thousand patients treated with drugs, about $330,000. Obviously a lot depends on longterm results — how many of the patients taking pills at the end of a year will continue to need them indefinitely? how many of the patients who don’t need pills after surgery will come to need them in the future? But a first cut suggests that breakeven for the surgical treatment will come only 12-13 years down the road; if you’re paying 6% for the money that funds the treatment, breakeven may never come at all.

I don’t know whether taking a pill for years on end is a cost that makes the surgery worthwhile, but I am betting that in another four years when the followup is finished we won’t be hearing much.

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