Most recent update: Thursday, March 26, 2020 - 15:09

Bariatric News - Cookies & privacy policy

You are here

DDW 2013

GERD: prompt pH monitoring test preferred to PPI use

Study claims pH monitoring should be "strongly considered"

More objective testing may substantially reduce the cost and risk of managing gastro-oesophageal reflux disease (GERD), according to a study presented at Digestive Disease Week in Orland, FL.

Researchers from New York Presbyterian Hospital and Weill-Cornell Medical College, reported that almost a third of patients undergoing treatment have no measurable signs of the chronic condition, and they projected cost-savings of up to US$7,300 per patient over ten years if current diagnostic guidelines were changed.

“Many patients remain on proton-pump inhibitors for years after the trial period without any confirmation that they are being treated for the right diagnosis,” said Dr David Kleiman, a research fellow from New York Presbyterian Hospital. “A prompt pH monitoring test could help clinicians to accurately diagnosis GERD, increase healthy outcomes for patients and save people money.”

The study compared proton-pump inhibitors (PPI) with 24-hour oesophageal pH monitoring.

A cost model was created from a third-party payer perspective over a ten-year period with the average wholesale unit prices of generic and name-brand PPIs obtained from the 2012 Micromedex Redbook. Low-dose (20mg daily) generic PPI and high-dose (40mg twice daily) name-brand PPI costs were used as the low-end and high-end PPI costs, respectively.

The cost of 24-hour pH monitoring and manometry, which was required to determine esophageal function and for appropriate positioning of the pH probe, was obtained from 2012 Medicare fees.

One hundred patients who underwent pH monitoring at an academic institution was retrospectively reviewed for type of GERD symptoms and duration of PPI use prior to pH monitoring. The sensitivity of 24-hour pH monitoring by literature review ranged from 30% to 96%. The cost of unnecessary PPIs was subtracted from the cost of pH monitoring for all patients to evaluate the cost-effectiveness.

They found that the weekly cost of PPIs ranged from US$29.06 to US$107.70, compared to the cost of 24-hour pH monitoring of US$690. The cost of PPI therapy reaches equivalence with pH monitoring after 6.4 to 23.7 weeks, depending on the PPI regimen.

Patients who experienced oesophageal and extra-oesophageal GERD symptoms reported a median of 208 and 52 weeks of PPI use, respectively, prior to referral. The cohort was prescribed a total of 21,411 weeks of PPIs beyond the initial eight-week trial, 32% of which were for patients who had a negative 24-hour pH monitoring study and were therefore unnecessary.

If the sensitivity of pH monitoring was 100%, they projected that performing pH monitoring on all patients after an eight-week PPI trial would have saved between US$1,966 and US$7,285 per patient over ten years. This strategy remains cost-effective as long as the sensitivity of pH monitoring is above 35%.

However, in this model, since patients with extra-oesophageal GERD symptoms were referred a median of 156 weeks sooner than patients with oesophageal symptoms, the cost savings were less.

They concluded that “most patients are maintained on PPIs for periods greatly surpassing the cost-equivalence point with 24-hour oesophageal pH monitoring. Early referral for pH monitoring after a brief empiric PPI trial may result in substantial cost savings for patients with both oesophageal and extra-oesophageal GERD symptoms.”

“The misconceptions about pH monitoring are that it’s unnecessary, expensive or too inconvenient,” said Kleiman. “But, the benefits seen in our study show that pH monitoring should be strongly considered.”

Want more stories like this? Subscribe to Bariatric News!

Bariatric News
Keep up to date! Get the latest news in your inbox. NOTE: Bariatric News WILL NOT pass on your details to 3rd parties. However, you may receive ‘marketing emails’ sent by us on behalf of 3rd parties.