Afaneh Cheguevara, Zoghbi Veronica, Finnerty Brendan M, Aronova Anna, Kleiman David, Ciecierega Thomas, Crawford Carl, Fahey Thomas J, Zarnegar Rasa
Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 294, New York, NY, 10065, USA.
Department of Pediatrics, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, 10065, USA.
Surg Endosc. 2016 Aug;30(8):3454-60. doi: 10.1007/s00464-015-4629-4. Epub 2015 Nov 4.
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.
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.
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.
BRAVO wireless pH testing is more cost-effective than prolonged empiric medical management for GERD and should be incorporated early in the treatment algorithm.
对于诊断胃食管反流病（GERD），早期转诊进行基于导管的食管pH监测比经验性质子泵抑制剂（PPI）治疗更具成本效益。我们推测，鉴于BRAVO无线pH监测具有更高的灵敏度和舒适度，与经验性PPI治疗相比，它也将显示出可观的成本节约。
我们回顾了在我们机构接受疑似GERD无线pH监测的100例连续患者。生成了一个成本模型和成本等效性计算。对食管和食管外症状均进行了成本节约分析。
87例患者可供分析。转诊前PPI使用的中位数为215周（范围0 - 520周）。43例患者（49%）BRAVO结果诊断为GERD；其中98%有食管症状。BRAVO研究结果为阴性的患者不必要的PPI治疗中位数为113周（0 - 520周）。每位患者的成本节约范围为1048美元至15853美元，具体取决于灵敏度（75% - 95%）、PPI剂量和品牌。食管外症状患者的成本节约最大（每位患者2948美元至31389美元）。BRAVO放置的PPI成本等效性对于低剂量和高剂量治疗分别为36周和6周。
对于GERD，BRAVO无线pH检测比长期经验性药物治疗更具成本效益，应在治疗方案中尽早采用。
