Original Article Economic burden of gastro-oesophageal reflux disease and dyspepsia: A community-based study Bijan Moghimi-Dehkordi a , Mohsen Vahedi a , Babak Khoshkrood Mansoori a , Amir Kasaeian b , Azadeh Safaee a,⇑ , Manijeh Habibi a , Asma Pourhoseingholi a , Mohammad Amin Pourhoseingholi a , Mohammad Reza Zali a a Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran b Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran article info Article history: Received 22 January 2011 Accepted 31 March 2011 Keywords: Economic burden Cost analysis Gastro-oesophageal reflux disease Dyspepsia Iran abstract Background and study aims: Gastro-oesophageal reflux disease (GERD) and dyspepsia are common diges- tive disorders that inflict serious harm, burden and economic consequences on individuals worldwide. The aim of this study was to estimate the direct and indirect economic burden of GERD and dyspepsia in the whole population of Tehran, the capital of Iran. Patients and methods: The study was performed on a total of 18,180 adult subjects (age > 18 years) taken as a random sample in Tehran province, Iran (2006–2007). A valid and reliable questionnaire was used to enquire about the symptoms of GERD, dyspepsia and the frequency of the utilization of health services including physician visits, hospitalisations and productivity loss due to GERD/dyspepsia symptoms in the preceding 6 months. Results: GERD was found in 518 (41.9% males) patients and dyspepsia in 404 patients (38.9% males). Fur- ther 1007 subjects had both GERD and dyspepsia. The total direct costs of disease per patient for GERD, dyspepsia and their overlap were PPP$97.70, PPP$108.10 and PPP$101.30, respectively (PPP, purchasing power parity dollars). The total indirect cost of disease per patient was PPP$13.7, PPP$12.1 and PPP$32.7, for GERD, dyspepsia and their overlap, respectively. Conclusion: According to our results, hospitalisation and physician visits were the main cost of disease that could be minimised by revision of the insurance business in Iran. Ó 2011 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. Introduction Gastro-oesophageal reflux disease (GERD), characterised by recurrent reflux of gastric contents into the oesophagus [1], is char- acterised by its high prevalence, variety of clinical presentations and substantial economic consequences [2,3]. While the typical symptoms of GERD are heartburn and regurgitation, it is also often associated with cough, asthma, hoarseness and chest pain [4–6]. Given the nature of the disorder, GERD has been shown to affect the quality of life and work productivity [7–10], and also to be associated with substantial costs, in terms of health-care costs and productivity loss [1,9,10]. Dyspepsia refers to a collection of upper gastrointestinal symp- toms that is believed to be common worldwide. Despite numerous consensus meetings [11–13], a standardised international defini- tion that is applicable to all populations remains controversial. This is partly due to the overlap with GERD and the cultural differences in reporting of symptoms [14,15]. Functional dyspepsia is not life threatening; however, the impact of this condition on patients and health-care services has been shown to be considerable [16]. Recent studies have shown that the direct costs of GERD and dyspepsia ranged between PPP$172 (purchasing power parity dol- lars) and PPP$176 per person per year and comprised more than 80% of the total cost of disease. Furthermore, medication costs, investigations and physician visits accounted for over one-half, one-third and one-fifth of the direct costs, respectively [17]. Willich et al. [18] reported the direct cost of GERD per person per year to be nearly €342 (equal to 396 PPP$). Schwenkglenks et al. [19] estimated that the direct cost of GERD is equal to CHF185 (equal to 110 PPP$). A Swedish study [20] reported the total cost of GERD or dyspepsia per person per year to be US$63 (equal to 63 PPP$). A few studies were conducted on the economic burden of GERD and dyspepsia in developing countries. This study aimed to esti- mate the direct and indirect economic burden of GERD and dys- pepsia in the whole population of Tehran, the capital of Iran. 1687-1979/$ - see front matter Ó 2011 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ajg.2011.03.005 ⇑ Corresponding author. Address: Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, 7th floor, Taleghani Hospital, Tabnak Street, Yaman Avenue, Velenjak, Tehran, Iran. Tel.: +98 2122432515; fax: +98 2122432517. E-mail address: azadesafaee@yahoo.com (A. Safaee). Arab Journal of Gastroenterology 12 (2011) 86–89 Contents lists available at ScienceDirect Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg