Optimizing the Management Algorithm for Heartburn in General Gastroenterology: Cost-Effectiveness and...

Area of Science:

• Gastroenterology
• Health Economics
• Clinical Decision Modeling

Background:

• Heartburn is a prevalent symptom in gastroenterology practice.
• Effective and economical management strategies for heartburn are needed.

Purpose of the Study:

• To optimize cost-effective evaluation and management of heartburn.
• To compare four strategies for patients with persistent heartburn despite empiric proton pump inhibitor (PPI) therapy.

Main Methods:

• A decision analytic model was developed comparing four management strategies.
• Strategies included PPI optimization, endoscopy with PPI optimization, PPI discontinuation based on findings, and endoscopy/reflux monitoring with phenotypic management.
• Cost and health outcomes were evaluated from insurer and patient perspectives over a 1-year horizon, with testing performed off PPI.

Main Results:

• PPI optimization without testing was the most expensive strategy.
• Endoscopy-based strategies improved health outcomes and reduced costs compared to no testing.
• Phenotype-guided management with endoscopy/ambulatory reflux monitoring and PPI discontinuation (when appropriate) yielded the greatest health gains (22 healthy days/year) and cost savings.

Conclusions:

• Endoscopy with ambulatory reflux monitoring, guided by patient phenotype, offers cost-effective heartburn management.
• For patients without erosive findings, trialing PPI discontinuation is more cost-effective than continuing PPI optimization.