When does testing for GERD become cost effective in an integrated health network?

Area of Science:

• Gastroenterology
• Health Economics

Background:

• Gastroesophageal reflux disease (GERD) is highly prevalent, affecting up to 14% of the US population.
• Rising esophageal adenocarcinoma rates persist despite chronic proton pump inhibitor (PPI) use, which does not normalize cancer risk.
• A significant portion of patients on PPI therapy may not have a confirmed GERD diagnosis and could potentially discontinue medication.

Purpose of the Study:

• To conduct a quality-assurance study on the care of patients on long-term, high-dose PPI therapy within an integrated healthcare network.
• To perform a cost-benefit analysis of diagnostic testing for patients on double-dose PPI therapy for over six months.

Main Methods:

• A cost-benefit analysis was conducted on a cohort of primary care patients insured within the network.
• Data from pharmacy, facility, physician reimbursement, and radiology departments were utilized.
• Break-even analysis was performed using a 4.5% discount rate.

Main Results:

• The study included 224 patients on double-dose PPI therapy for over six months.
• Bravo testing with esophagogastroduodenoscopy (EGD) to identify patients who could stop PPIs had a break-even point of 33 months.
• More comprehensive testing strategies (Bravo + EGD + manometry; Bravo + barium swallow + EGD; Bravo + barium swallow + manometry + EGD) had break-even points ranging from 38 to 47 months.

Conclusions:

• Early implementation of diagnostic tests such as upper endoscopy, Bravo testing, barium swallow, and manometry can yield significant cost savings.
• These diagnostic strategies help identify patients unnecessarily treated with double-dose PPIs for presumptive GERD.
• Early diagnostic testing also facilitates the prompt identification of other clinically significant pathologies.