Lee W C, Yeh Y C, Lacy B E, Pandolfino J E, Brill J V, Weinstein M L, Carlson A M, Williams M J, Wittek M R, Pashos C L
HERQuLES, Abt Associates Inc. Bethesda, MD 20814-3343, USA.
Curr Med Res Opin. 2008 May;24(5):1317-27. doi: 10.1185/030079908x280680. Epub 2008 Mar 27.
Current guidelines recommend the use of pH monitoring to confirm the diagnosis of acid reflux in patients with a normal endoscopy. This analysis evaluated the financial impact of pH monitoring with the wireless pH capsule on a managed care organization (MCO) in the United States.
A decision model was constructed to project total 1-year costs to manage GERD symptoms with and without the adoption of wireless pH capsules in a hypothetical MCO with 10 000 eligible adult enrollees, of whom 600 presented with GERD-like symptoms. Costs of GERD diagnosis, treatment, and symptom management for those in whom a GERD diagnosis was ruled out by pH monitoring were assessed. The incremental per-member-per-month (PMPM) and per-treated-member-per-month (PTMPM) costs were the primary outcomes. Data sources included literature, expert input, and standardized fee schedules.
An increase of 10 percentage points in the use of pH monitoring with wireless pH capsules yielded incremental PMPM and PTMPM costs of $0.029 and $0.481, respectively. The costs of proton pump inhibitor (PPI) therapy to the plan dropped to $236,363 from $238,086, while increases were observed in pH monitoring (from $16 739 to $21 973) and non-GERD therapy costs (from $1392 to $1740). The results were sensitive to the percentage of patients requiring repeat endoscopy before wireless pH monitoring and the cost of PPIs.
Timely and increased use of pH monitoring as recommended in published guidelines leads to less unnecessary use of PPIs with a modest budgetary impact on health plans.
当前指南建议使用pH监测来确诊内镜检查结果正常的患者的胃酸反流情况。本分析评估了无线pH胶囊pH监测对美国一家管理式医疗组织（MCO）的财务影响。
构建一个决策模型，以预测在一个有10000名符合条件的成年参保人的假设性MCO中，采用和不采用无线pH胶囊管理胃食管反流病（GERD）症状的1年总成本，其中600人表现出GERD样症状。评估了pH监测排除GERD诊断的患者的GERD诊断、治疗和症状管理成本。主要结果是每月每位成员（PMPM）和每月每位接受治疗的成员（PTMPM）的增量成本。数据来源包括文献、专家意见和标准化收费表。
使用无线pH胶囊进行pH监测的比例增加10个百分点，PMPM和PTMPM的增量成本分别为0.029美元和0.481美元。该计划的质子泵抑制剂（PPI）治疗成本从238,086美元降至236,363美元，而pH监测成本（从16,739美元增至21,973美元）和非GERD治疗成本（从1392美元增至1740美元）有所增加。结果对无线pH监测前需要重复内镜检查的患者比例和PPI成本敏感。
按照已发表指南的建议及时增加pH监测的使用，可减少PPI的不必要使用，对健康计划的预算影响不大。
