Early Referral for Esophageal pH Monitoring Is More Cost-Effective Than Prolonged Empiric Trials of Proton-Pump Inhibitors for Suspected Gastroesophageal Reflux Disease

• Published in: Journal of gastrointestinal surgery Vol. 18; no. 1; pp. 26 - 34
• Main Authors: Kleiman, David A., Beninato, Toni, Bosworth, Brian P., Brunaud, Laurent, Ciecierega, Thomas, Crawford, Carl V., Turner, Brian G., Fahey, Thomas J., Zarnegar, Rasa
• Format: Journal Article
• Language: English
• Published: Boston Springer US 2014; Springer Nature B.V; Springer Verlag
• Subjects: 2013 SSAT Plenary Presentation; Adolescent; Adult; Aged; Aged, 80 and over; Cost analysis; Cost control; Cost-Benefit Analysis; Esophageal pH Monitoring - economics; Esophagus; Female; Gastroenterology; Gastroesophageal reflux; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - economics; Health Care Costs; Humans; Life Sciences; Male; Medical records; Medical schools; Medicine; Medicine & Public Health; Middle Aged; Models, Economic; Monitoring systems; Patients; Proton Pump Inhibitors - economics; Proton Pump Inhibitors - therapeutic use; Protons; Referral and Consultation; Sensitivity and Specificity; Surgery; Time Factors; Young Adult; New York; United States > US; Reflux; GERD; Esophageal pH monitoring; Gastroesophageal reflux disease; PPI; Cost analysis; Proton-pump inhibitor
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-013-2327-x

Introduction The most cost-effective diagnostic algorithm for gastroesophageal reflux disease (GERD) remains controversial. We hypothesized that prompt referral for esophageal pH monitoring is more cost-effective than prolonged empiric courses of proton-pump inhibitors (PPIs). Discussion A cost model was created based on a cohort of 100 patients with possible GERD who underwent pH monitoring. The additional costs incurred from pH monitoring were compared to the potential savings from avoiding unnecessary PPI usage in patients with a negative pH study. The costs of PPI therapy reach equivalence with pH monitoring after 6.4 to 23.7 weeks, depending on the PPI regimen. A total of 21,411 weeks of PPIs were prescribed beyond the recommended 8-week trial, of which 32 % were for patients who had a negative 24-h pH monitoring study. If the sensitivity of pH monitoring was 96 %, early referral for pH monitoring would have saved between $1,197 and $6,303 per patient over 10 years. This strategy remains cost-effective as long as the sensitivity of pH monitoring is above 35 %. Prompt referral for pH monitoring after a brief empiric PPI trial is a more cost-effective strategy than prolonged empiric PPI trials for patients with both esophageal and extraesophageal GERD symptoms.