BRAVO esophageal pH monitoring: more cost-effective than empiric medical therapy for suspected gastroesophageal reflux
BRAVO esophageal pH monitoring: more cost-effective than empiric medical therapy for suspected gastroesophageal reflux
复制标题
DOI：
10.1007/s00464-015-4629-4
复制
发表时间：
2016-08-01
影响因子：
3.1
通讯作者：
Zarnegar, Rasa
中科院分区：
文献类型：
--
作者：
Afaneh, Cheguevara;Zoghbi, Veronica;Zarnegar, Rasa
在诊断胃食道反流病(GERD)时，早期转诊基于导管的食道pH监测比经验性质子泵抑制剂(PPI)治疗更具成本效益。我们假设，与经验性PPI疗法相比，Bravo无线pH监测也将显示出显著的成本节约，因为它具有卓越的敏感性和舒适性。我们回顾了在我们机构接受无线pH监测疑似GERD的100名患者。生成了成本模型和成本当量计算。对食道和食道外症状进行了成本节约分析。87名患者可用于分析。转诊前PPI使用的中位数为215周(范围0-520)。43名患者(49%)的Bravo结果诊断为GERD；其中98%有食道症状。Bravo试验阴性的患者接受不必要的PPI治疗的中位数为113(0-520)周。根据敏感性(75%-95%)、PPI剂量和品牌的不同，每个患者节省的成本从1048美元到15853美元不等。最大限度地节省成本的是有食道外症状的患者(每个患者2948-31,389美元)。对于低剂量和高剂量治疗，BRAVO放置的PPI成本当量分别为36周和6周。BRAVO无线pH测试比长期经验性医疗管理对GERD更具成本效益，应尽早纳入治疗算法。
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.