The AGA has issued a Technology Coverage Statement on minimally invasive surgical options for GERD, recommending that transoral fundoplication should be covered and reimbursed for appropriate patients.
AGA Technology Coverage Statements are designed to be shared with payors to help members obtain coverage and reimbursement for proven procedures, diagnostics and therapies, according to AGA’s website.
As the AGA medical position statement on GERD management was last updated in 2008, a multidisciplinary work force developed the AGA Episode Payment Framework for Gastroesophageal Reflux Disease to address medical and surgical options based on recent data. The Technology Coverage Statement specifically addresses the transoral incisionless fundoplication (TIF) procedure, citing randomized controlled trial data on TIF performed with the EsophyX device (EndoGastric Solutions).
The procedure, which involves mechanically recreating the gastroesophageal valve by placing sutures or fasteners in the lower esophageal sphincter to strengthen and lengthen it, “delivers patient outcomes similar to those provided by conventional anti-reflux surgery (ARS) procedures and does not limit future treatment options,” according to the statement.
The statement concludes that “the 3-year plus evidence is sufficient to demonstrate sustainable improvement in health outcomes, symptom relief, decrease in PPI utilization and improvement in esophageal pH with transoral fundoplication,” and that the procedure should be covered and reimbursed for patients meeting selection criteria.
“This statement by the AGA is important for advocacy work with payers,” Philip Macdonald, EndoGastric Solutions’ vice president of healthcare economics, policy and reimbursement, said in a press release. “Publishing new guidelines can be time consuming and cost prohibitive. The evolution of data-proven technologies to treat chronic diseases is accelerating so the Technology Coverage Statement by the AGA can help fill the gap during the society’s guideline review cycle. This ensures society membership is able to provide safe and effective treatments for chronic disease sufferers sooner.”
AGA. Technology coverage statement on minimally invasive surgical options for gastroesophageal reflux disease. Available at: www.gastro.org/about/Technology_Coverage_Minimally_Invasive_GERD_Procedures.pdf. Accessed June 20, 2016.
Disclosure: Macdonald is employed by EndoGastric Solutions.