The characteristics of antireflux surgery compared to proton pump inhibitor treatment in Korea: a nationwide study using claim data from 2007 to 2016

Susan Park,Jin-Won Kwon,Joong-Min Park,Sungsoo Park,Jinseub Hwang,Kyung Won Seo 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.98 No.5

Purpose: Laparoscopic antireflux surgery is not widely used in Korea, but published data suggest that its results are comparable to those of Western countries. The purpose of this study was to compare the clinical characteristics, medical utilization, and medical costs of antireflux surgery and proton pump inhibitor (PPI) treatments. Methods: We used Korean patients who underwent fundoplication (n = 342, surgery group) and a 25% random sample of all patients diagnosed with gastroesophageal reflux disease (GERD) who were prescribed PPIs for more than 12 weeks (n = 130,987, medication group) between 2007 to 2016. We compared medical costs and utilization between the 2 groups. Results: The average cost of fundoplication was $4,631. The costs of GERD treatment in the first year after surgery and during the follow-up period were $78.1 and $50.1 per month, respectively. In the surgery group, the average monthly medical expenses decreased as the year progressed, but the average monthly medical expenses ($137.5 per month) did not decrease in the medication group. After stratifying by age group, the medical costs of the surgery group were lower than those of the medication group for all ages except for patients between the ages of 70 and 79. The cost difference between the 2 groups was prominent between the ages of 20 and 49. Conclusion: This study showed that a significant decrease in cost was observed 1 year after surgery, and it was more apparent in younger patients. Further research is needed to determine the appropriateness of antireflux surgery for each group of patients.

Treatment Pattern and Economic Burden of Refractory Gastroesophageal Reflux Disease Patients in Korea

( Susan Park ),( Jin-won Kwon ),( Joong-min Park ),( Sungsoo Park ),( Kyung Won Seo ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.2

Background/Aims The prevalence of gastroesophageal reflux disease (GERD) has increased in Korea, and the economic burden of this chronic disease is substantial. We aim to investigate the treatment pattern and economic burden in Korea of refractory GERD requiring long-term use of proton pump inhibitors (PPIs). Methods We conducted a cross-sectional analysis of nationally representative sample data obtained from 2012 to 2016 and provided by the Health Insurance Review and Assessment Service. The participants were 86 936 in the medication group and 40 in the surgery group. Age- and sex-standardized prevalence of refractory GERD requiring PPIs medication for more than 12 weeks were analyzed. Generalized linear models were used to estimate cost ratios for comparing the medical costs of the surgery and medication groups after adjustment for demographics and comorbidity. Results The prevalence of refractory GERD increased from 1.2% in 2012 to 1.9% in 2016, and the estimated total number of GERD patients increased from 402 000 to 736 000 during this time period. The medical expenditures of the surgery group within 90 days of antireflux surgery (ARS) were 16.9-fold higher compared to those of the medication group; the significant difference in medical costs between the 2 groups disappeared after 90 days post-surgery. Conclusions The prevalence of refractory GERD requiring long-term use of PPIs has been trending upwards recently. Nevertheless, ARS is very rarely performed. Considering the increasing medical costs of long-term PPI use, further cost-effectiveness analysis is needed to compare ARS and PPI therapy for the treatment of GERD in Korea. (J Neurogastroenterol Motil 2020;26:281-288)

Anti-reflux Surgery Versus Proton Pump Inhibitors for Severe Gastroesophageal Reflux Disease: A Cost-Effectiveness Study in Korea

( Susan Park ),( Sungsoo Park ),( Joong-min Park ),( Soorack Ryu ),( Jinseub Hwang ),( Jin-won Kwon ),( Kyung Won Seo ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.2

Background/Aims The economic burden for gastroesophageal reflux disease (GERD) has recently increased in Asian countries. This study investigates the cost-effectiveness between anti-reflux surgery and medication, with proton pump inhibitors (PPIs) for GERD in Korea. Methods We used a decision tree and Markov model to obtain the costs and quality-adjusted life years (QALYs) of the surgical and medical strategies. Our target cohort was the severe GERD patients aged 50 years old who required a continuous double dose of PPIs. The time horizon was 10 years and all estimates were discounted at 5% per year. The incremental cost-effectiveness ratio of the anti-reflux surgery compared with medication with PPIs was calculated. Sensitivity analyses were performed on all relevant variables. Results The cost-utility analysis indicated anti-reflux surgery was more cost-effective than medication among severe GERD patients over a 10- year period. The model predicted that the surgical strategy had a cost savings of $551 and the QALYs had a gain of 1.18 as compared with the medical strategy. The break-even point in costs of the anti-reflux surgery over the medication was estimated to be 9 years. Sensitivity analyses using the varying parameter assumptions demonstrated the robustness of the study results. Conclusions This study showed anti-reflux surgery was less expensive and more effective therapy over the PPI medication after 9 years of follow-up. This suggests the surgical strategy is a cost-effective alternative to PPI medication among patients who need long-term management for GERD in Korea. (J Neurogastroenterol Motil 2020;26:215-223)

What cigarette price is required for smokers to attempt to quit smoking? Findings from the ITC Korea Waves 2 and 3 Survey

Park, Eun-Ja,Park, Susan,Cho, Sung-il,Kim, Yeol,Seo, Hong Gwan,Driezen, Pete,Quah, Anne C K,Fong, Geoffrey T BMJ Publishing Group Ltd 2015 Tobacco control Vol.24 No.suppl3

<P>Objectives We assess the cigarette price that would motivate smokers to quit. We also explore the factors associated with the required price, including exposures to non-tax tobacco control policies. Methods Cross-sectional analysis was conducted on data from 1257 male smokers, who participated in either Wave 2 or 3 of the ITC Korea Survey. Information was obtained on what cigarette price per pack would make them try to quit (price to quit'). Tobit regression on log-transformed price and logistic regression on non-quitting were conducted to identify associated factors. Results The median price to quit was KRW5854 (US$5.31)/pack, given the current price of KRW2500 (US$2.27)/pack. Younger age, higher education, lack of concern about the health effects of smoking, lack of quit attempts and more cigarettes consumed per day were related to a higher price needed for a quit attempt. Exposures to combinations of non-tax policies were significantly associated with lower price levels to be motivated to quit. Conclusions Considering the large price increase required for quit attempts, tax policy needs to be combined with other policies, particularly for certain groups, such as heavy smokers. Strengthening non-tax policies is likely to facilitate greater responsiveness to tax policy.</P>

사회적 관계망의 긍정적, 부정적 기능이 성별 주관적 건강에 미치는 영향

박수잔(Susan Park),조성일(Sung-Il Cho),장숙랑(Soong-Nang Jang) 한국보건교육건강증진학회 2011 보건교육건강증진학회지 Vol.28 No.4

Objectives: This study was to examine the association between structural and functional characteristics of social network and self-rated health in middle-aged Korea population. We also explored gender difference in the relationship between social network and health. Methods: Data were collected from individuals aged 40-69 years old participating in the 2005 survey for the Korean Genome & Epidemiology Study. We examined the association between social network, social support, social conflict and self-rated health using multiple logistic regression analysis stratified by gender. Results: The extent and contact frequency of close people, and social participations were associated by not only the positive function but also the negative function of social network. Both the positive and negative functions of social network affected self-rated health. The relationship between the function of social network and health showed a gender difference: only positive function was significantly associated with health in men while only negative function had significant relationship with health in women. Conclusions: Social support and social conflict affected the health in both genders through different ways. The ambivalent effect of social network on health should be explored further.

텍스트 마이닝과 토픽 모델링을 이용한 성조숙증 관련 인터넷 건강상담 분석

박수잔(Susan Park),서영균(Young-Kyoon Suh),김재성(Jaesung Kim),권진원(Jin-Won Kwon) 한국보건교육건강증진학회 2020 보건교육건강증진학회지 Vol.37 No.3

Objectives: This study aimed to investigate the characteristics of the demand for precocious puberty-related health information using the text data of online health counseling through the techniques of text mining and topic modeling. Methods: The input data of this study were question and answer documents that were searched for Naver Jisik-iN using the keywords precocious puberty. The documents were automatically collected using a web crawler from January 2017 to June 2019. We performed text pre-processing, after which all nouns were extracted using a morphological analyzer. LDA(Latent Dirichlet Allocation) topic modeling was performed to find hidden themes in the text. Results: A majority of questions were submitted during the school vacation. Approximately half of all questions were answered by doctors. We used LDA topic modeling to yield three themes regarding precocious puberty-related questions: 1) asking for expert opinion on diagnosis or hospital selection, 2) questions regarding diagnostic tests and treatment, and 3) questions considering obesity and/or diet, as well as timing of puberty onset. Conclusion: This study identified the major precocious puberty-related concerns. In light of the increasing incidence of precocious puberty, individuals with this condition, as well as parents, should be provided with appropriate education to promote awareness and management.

한국인 대상 식사염증지수와 대사증후군 판정지표의 관련성 분석

박수산(Susan Park),김미성(Misung Kim),손정민(Cheonmin Sohn) 한국생활과학회 2016 한국생활과학회 학술대회 Vol.2016 No.11

Poster Session : PS 1504 ; Rheumatology : Leukocyte-Specifl c Protein1 Regulates T Cell Migration and Infl ammatory Arthritis

( Yune Jung Park ),( Seong Hye Hwang ),( Seung Hyun Jung ),( Sa Seong Lee ),( Susan Na Choi ),( Seung Ah Yoo ),( Ji Hwan Park ),( Dae Hee Hwang ),( Seung Cheol Shim ),( Chul Soocho ),( Yeun Jun Chung 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Copy number variations (CNVs) have been implicated in human diseases. However, it remains unclear how they affect immune dysfunction and autoimmune diseases, including rheumatoid arthritis (RA). Methods: To de. ne CNVs, we used SNP genotyping data from the 500 discovery set. The Lsp1 plasmid DNA was tagged with GFP and was then transfected into Jurkat cells. Mice genetically de. cient in Lsp1 (Lsp1 ./. mice) were induced of delayed-type hypersensitivity and antigen-induced arthritis. Results: Here, we identi. ed a novel Lsp1 deletion variant for RA susceptibility. Differentially expressed genes in Lsp1-de. cient primary T cells represent cell motility and immune and cytokine responses. Functional assays demonstrated that LSP1, induced by T cell receptor activation, negatively regulates T cell migration by hampering ERK activation in vitro. In mice with T cell-dependent chronic in. ammation, loss of Lsp1 promotes migration of T cells into the target tissues as well as draining lymph nodes, exacerbating disease severity. Moreover, RA patients show diminished expression of LSP1 in peripheral T cells with increased migratory capacity. Conclusions: Our data highlights the importance of Lsp1 CNVs in the pathogenesis of immune diseases and provides novel insights into the mechanisms underlying T cell migration toward the in. amed synovium in RA.

Positional Cloning and Phenotypic Characterization of a New Mutant Mouse with Neuronal Migration Abnormality

Park Chankyu,Ackerman Susan-L 한국발생생물학회 2001 한국발생생물학회 학술발표대회 Vol.2001 No.-

Positional clonging (map-based cloning) of mutations or genetic variations has been served as an invaluable tool to understand in-vivo functions of genes and to identify molecular components underlying phenotypes of interest. Mice homozygous for the cerebellar deficient folia (cdf) mutation are ataxic, with cerebellar hypoplasia and abnormal lobulation of the cerebellum. In the cdf mutant cerebellum approximately 40% of Purkinje cells are ectopically located within the white matter and the inner granule cell layer (IGL). To identify the cdf gene, a high-resolution genetic map for the cdf-gene-encompassing region was constructed using 1997 F2 mice generated from C3H/HeSnJ-cdf/cdf and CAST/Ei intercross. The cdf gene showed complete linkage disequilibrium with three tightly linked markers D6Mit208, D6Mit359, and D6Mit225. A contig using YAC, BAC, and P1 clones was constructed for the cdf critical region to identify the gene. A deletion in the cdf critical region on chromosome 6 that removes approximately 150 kb of DNA selection. cdf mutant mice with the transgenic copy of the identified gene restored the brain abnormalities of the mutant mice. The positional cloning of cdf gene provides a good example showing the identification of a gene could lead to finding a new component of important molecular pathways.

Na⁺/H⁺ Exchanger Regulatory Factor 3 Is Critical for Multidrug Resistance Protein 4-Mediated Drug Efflux in the Kidney

Park, Joonhee,Kwak, Jin-Oh,Riederer, Brigitte,Seidler, Ursula,Cole, Susan P.C.,Lee, Hwa Jeong,Lee, Min Goo American Society of Nephrology 2014 Journal of the American Society of Nephrology Vol.25 No.4

<P>Na(+)/H(+) exchanger regulatory factor 3 (NHERF3) is a PSD-95/discs large/ZO-1 (PDZ)-based adaptor protein that regulates several membrane-transporting proteins in epithelia. However, the in vivo physiologic role of NHERF3 in transepithelial transport remains poorly understood. Multidrug resistance protein 4 (MRP4) is an ATP binding cassette transporter that mediates the efflux of organic molecules, such as nucleoside analogs, in the gastrointestinal and renal epithelia. Here, we report that Nherf3 knockout (Nherf3(-/-)) mice exhibit profound reductions in Mrp4 expression and Mrp4-mediated drug transport in the kidney. A search for the binding partners of the COOH-terminal PDZ binding motif of MRP4 among several epithelial PDZ proteins indicated that MRP4 associated most strongly with NHERF3. When expressed in HEK293 cells, NHERF3 increased membrane expression of MRP4 by reducing internalization of cell surface MRP4 and consequently, augmented MRP4-mediated efflux of adefovir, a nucleoside-based antiviral agent and well known substrate of MRP4. Examination of wild-type and Nherf3(-/-) mice revealed that Nherf3 is most abundantly expressed in the kidney and has a prominent role in modulating Mrp4 levels. Deletion of Nherf3 in mice caused a profound reduction in Mrp4 expression at the apical membrane of renal proximal tubules and evoked a significant increase in the plasma and kidney concentrations of adefovir, with a corresponding decrease in the systemic clearance of this drug. These results suggest that NHERF3 is a key regulator of organic transport in the kidney, particularly MRP4-mediated clearance of drug molecules.</P>