Timely confirmation of gastro-esophageal reflux disease via pH monitoring: estimating budget impact on managed care organizations

Lee, Won Chan; Yeh, Yu-Chen; Lacy, Brian E.; Pandolfino, John E.; Brill, Joel V.; Weinstein, M. L.; Carlson, Angeline M.; Williams, Melissa; Wittek, Michael R.; Pashos, Chris L.

doi:10.1185/030079908x280680

Cited by 17 publications

(8 citation statements)

References 21 publications

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“…However, this was a non-randomized study and thus confounding by assignment bias may have overestimated the tolerability of manometric placement. Finally, although a cost analysis on endoscopically-placed WC has been performed [11], no study has assessed this question with transoral placement or from the perspective of a publicly funded health care system where time costs to patients and caregivers should be considered [12]. …”

Section: Introductionmentioning

confidence: 99%

Unsedated peroral wireless pH capsule placement vs. standard pH testing: A randomized study and cost analysis

et al. 2012

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BackgroundWireless capsule pH-metry (WC) is better tolerated than standard nasal pH catheter (SC), but endoscopic placement is expensive. Aims: to confirm that non-endoscopic peroral manometric placement of WC is as effective and better tolerated than SC and to perform a cost analysis of the available esophageal pH-metry methods.MethodsRandomized trial at 2 centers. Patients referred for esophageal pH testing were randomly assigned to WC with unsedated peroral placement or SC after esophageal manometry (ESM). Primary outcome was overall discomfort with pH-metry. Costs of 3 different pH-metry strategies were analyzed: 1) ESM + SC, 2) ESM + WC and 3) endoscopically placed WC (EGD + WC) using publicly funded health care system perspective.Results86 patients (mean age 51 ± 2 years, 71% female) were enrolled. Overall discomfort score was less in WC than in SC patients (26 ± 4 mm vs 39 ± 4 mm VAS, respectively, p = 0.012) but there were no significant group differences in throat, chest, or overall discomfort during placement. Overall failure rate was 7% in the SC group vs 12% in the WC group (p = 0.71). Per patient costs ($Canadian) were $1475 for EGD + WC, $1014 for ESM + WC, and $906 for ESM + SC. Decreasing the failure rate of ESM + WC from 12% to 5% decreased the cost of ESM + WC to $991. The ESM + SC and ESM + WC strategies became equivalent when the cost of the WC device was dropped from $292 to $193.ConclusionsUnsedated peroral WC insertion is better tolerated than SC pH-metry both overall and during placement. Although WC is more costly, the extra expense is partially offset when the higher patient and caregiver time costs of SC are considered.Trial registrationClinicaltrials.gov Identifier NCT01364610

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Section: Introductionmentioning

confidence: 99%

Unsedated peroral wireless pH capsule placement vs. standard pH testing: A randomized study and cost analysis

et al. 2012

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“…The average EGD/patient was 2. [1][2][3][4][5][6][7][8][9][10] The average GERD-Health Related Quality of Life, Reflux Symptom Index, and GERD Symptom Score were 32 ± 18, 23 ± 14, and 25 ± 12, respectively. The Health Satisfaction Survey completed by 357/379 (94.2%) patients showed that 250/357 (70.0%) were dissatisfied with the control of their GERD symptoms ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…A model examining the budgetary impact of strict adherence to the current GERD algorithm on a hypothetical managed care organization showed modest financial impact even with a 10 percentage point increase of utilization of the Bravo capsule. 9 However, it is reported that adherence to the current protocol among gastroenterologists ranges from 62.5% to 88.7%. 10 In the current study, we focused on the procedural cost in three clinical scenarios.…”

Section: Discussionmentioning

confidence: 99%

Drawbacks of the Current Algorithm for Patients With Symptoms of Gastroesophageal Reflux Disease and the Impact of Adding Wireless pH Study to the Initial Diagnostic Endoscopy: Data From High-Volume Rural Antireflux Center

Fanous

Hughes

2020

The American Surgeon™

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Background Patients with symptoms of gastroesophageal reflux disease (GERD) are often given a trial of proton pump inhibitors (PPIs). When they respond, patients usually continue PPI therapy. If this empiric treatment fails, esophagogastroduodenoscopy (EGD) is recommended. When EGD findings are equivocal, pH study is warranted. We hypothesize that this algorithm results in prolonged PPI therapy, repetition of EGDs and patient dissatisfaction. This study evaluates the impact of placing a pH probe at the time of the initial EGD. Methods IRB approval was obtained for retrospective chart review of patients who presented with GERD symptoms between August 2015 and March 2019. Patients were included if they underwent EGD with placement of wireless pH probe. Results A total of 379 patients (260 females, 119 males) with average age was 56.7±14.2 years. There were 253/379 (66.7%) patients who had previous EGDs (1-10). Health Satisfaction Survey was completed by 357/379 (94.2%) patients and 250/357 (70%) reported dissatisfaction with GERD control. PPI use was noted in 299/379 (78.8%) patients with average duration of 10.9±9.1 years. Testing off antisecretory medication was performed in 360/379 (94.9%). The average time interval between the clinic visit and performing EGD and pH study was 22±25 days. Conclusion The current GERD algorithm results in prolonged PPI therapy, repeated endoscopies and patient dissatisfaction. Placing a pH probe at the time of initial endoscopy is safe and expedient in a rural setting. Positive pH studies avoid repeating EGDs and negative pH studies warrant a search for potential alternative diagnosis.

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“…When medication cost is included, a judicious strategy of esophageal pH testing in selected patients was found to potentially reduce overall cost. 61 Nonetheless, it seems reasonable for the primary care physician to try 1 or 2 rounds of empirical treatments, but if the patient does not respond, referral to a cough specialty clinic is recommended. 62 A series of specialty referrals typically results in fragmented and confused care.…”

Section: Primary Carementioning

confidence: 99%

Chronic Cough: An Update

Iyer

Lim

2013

Mayo Clinic Proceedings

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Cough persisting beyond 8 weeks (ie, chronic cough) is one of the most common reasons for an outpatient visit. A protracted cough can negatively affect one's quality of life by causing anxiety, physical discomfort, social isolation, and personal embarrassment. Herein, the anatomy and physiology of the cough reflex are reviewed. Upper airway cough syndrome, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease account for most chronic cough after excluding smoking, angiotensin-converting enzyme inhibitor use, and chronic bronchitis. Many patients have more than one reason for chronic cough. Treating the underlying cause(s) resolves cough in most instances. There are some coughs that seem refractory despite an extensive work-up. The possibility of a hypersensitive cough reflex response has been proposed to explain these cases. Several clinical algorithms to evaluate chronic cough are presented.

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Timely confirmation of gastro-esophageal reflux disease via pH monitoring: estimating budget impact on managed care organizations

Cited by 17 publications

References 21 publications

Unsedated peroral wireless pH capsule placement vs. standard pH testing: A randomized study and cost analysis

Unsedated peroral wireless pH capsule placement vs. standard pH testing: A randomized study and cost analysis

Drawbacks of the Current Algorithm for Patients With Symptoms of Gastroesophageal Reflux Disease and the Impact of Adding Wireless pH Study to the Initial Diagnostic Endoscopy: Data From High-Volume Rural Antireflux Center

Chronic Cough: An Update

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