Abstract
Introduction
Early referral for catheter-based esophageal pH monitoring is more cost-effective than empiric proton-pump inhibitor (PPI) therapy to diagnose gastroesophageal reflux disease (GERD). We hypothesize that BRAVO wireless pH monitoring will also demonstrate substantial cost-savings compared to empiric PPI therapy, given its superior sensitivity and comfort.
Methods
We reviewed 100 consecutive patients who underwent wireless pH monitoring for suspected GERD at our institution. A cost model and a cost equivalence calculation were generated. Cost-saving analyses were performed for both esophageal and extraesophageal symptoms.
Results
Eighty-seven patients were available for analysis. Median PPI use prior to referral was 215 weeks (range 0–520). Forty-three patients (49 %) had BRAVO results diagnosing GERD; 98 % of these had esophageal symptoms. Patients with negative BRAVO studies had a median of 113 (0–520) weeks of unnecessary PPI therapy. Cost-savings ranged from $1048 to $15,853 per patient, depending on sensitivity (75–95 %), PPI dosage, and brand. Maximum cost-savings occurred in patients with extraesophageal symptoms ($2948–$31,389 per patient). The PPI cost equivalence of BRAVO placement was 36 and 6 weeks for low- and high-dose therapy, respectively.
Conclusions
BRAVO wireless pH testing is more cost-effective than prolonged empiric medical management for GERD and should be incorporated early in the treatment algorithm.
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Acknowledgments
The authors thank the assistance of Shafika Elder, MA for the careful review of our statistical modeling in the preparation of this manuscript.
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Cheguevara Afaneh, Veronica Zoghbi, Brendan M. Finnerty, Anna Aronova, David Kleiman, Thomas Ciecierega, Carl Crawford, Thomas J. Fahey III, and Rasa Zarnegar have no conflicts of interest or financial ties to disclose.
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Cheguevara Afaneh and Veronica Zoghbi have contributed equally to this work.
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Afaneh, C., Zoghbi, V., Finnerty, B.M. et al. BRAVO esophageal pH monitoring: more cost-effective than empiric medical therapy for suspected gastroesophageal reflux. Surg Endosc 30, 3454–3460 (2016). https://doi.org/10.1007/s00464-015-4629-4
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DOI: https://doi.org/10.1007/s00464-015-4629-4