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Nothing Tough to Swallow About This Data

Ethicon's Linx reflux management system reduced medical costs enough that it more than offsets the higher procedure cost compared to a more invasive anti-reflux surgery, according to a study presented at SAGES 2019.

Linx is a flexible ring of small magnets (shown above) designed to be placed around the lower part of the esophagus, the body’s natural barrier to reflux, during a minimally invasive procedure. The magnetic ring expands when a patient swallows to allow food to enter the stomach but then contracts to prevent stomach contents from flowing back into the esophagus and causing GERD.

Ethicon (part of Johnson & Johnson)

Sometimes providing value-based care means spending more money up front by choosing a procedure that reduces the patient's medical costs over time through improved outcomes. That's the case made by the authors of a recent study comparing the cost-effectiveness of Ethicon's Linx reflux management system to laparoscopic Nissen fundoplication (LNF).

“The higher initial cost of a Linx procedure compared to a Nissen fundoplication is perceived as a drawback by insurers, which made getting insurance approvals challenging,” said lead researcher Blair Jobe, MD, director of the Esophageal and Lung Institute at the Allegheny Health Network. “This study suggests that perception may be short-sighted in that insurance plans can provide better care for their GERD patients at a similar cost to laparoscopic Nissen fundoplication when you factor in the greater reductions in medical costs after the procedure.” 

The study, presented this week at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting in Baltimore, MD, found that the reduced medical costs associated with the Linx procedure compared to LNF more than offset the higher cost the cost difference. The study was partially funded by Ethicon, part of Johnson & Johnson, which acquired the technology in 2017. Highmark Healths Vital Innovation Program collaborated on the research.

The prospective observational study was performed at Highmark Health’s Allegheny Health Network, a health system serving western Pennsylvania, in conjunction with Highmark Inc., the region’s largest health insurance company. Researchers compared the total procedural cost and the disease-related and overall medical claim costs 12 months before and 12 months after a Linx procedure (180 patients) or LNF (1,131 patients). 

The study found the mean per member per month (PMPM) medical reimbursement claims related to upper gastrointestinal disease one year after Linx dropped by 66%  ($305 to $104) compared to 46% ($233 to $126) after LNF. Overall PMPM medical reimbursement claims decreased by 10.7% for Linx patients and only by 1.4% for LNF patients. Specific reimbursements for proton pump inhibitors, acid suppression drugs for GERD, dropped by 95% after Linx and by 90% after LNF.

The median cost of a Linx procedure was $13,522 (mean $14,379) and $13,388 (mean$13,691) for LNF, a difference that researchers say is offset or surpassed by a lower cost of care for the insurer in the one year following surgery. 

Linx is a flexible ring of small magnets surgeons place around the lower part of the esophagus, the body’s natural barrier to reflux, during a minimally invasive procedure. The magnetic ring expands when a patient swallows to allow food to enter the stomach but then contracts to prevent stomach contents from flowing back into the esophagus and causing GERD. In LNF, a surgeon wraps a portion of the upper stomach (fundus) around the lower part of the esophagus to help prevent acid from moving up into the esophagus.

Previous studies on Linx showed 88% of patients reported that bothersome heartburn had been eliminated five years after treatment, 85% were free from dependence on daily reflux medication, and 99% of patients eliminated regurgitation, a common symptom of GERD. Patients also report significant improvements in quality of life, Ethicon noted.

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