Timely confirmation of gastroesophageal reflux disease via pH monitoring: estimating budget impact on managed care organizations
Timely confirmation of gastroesophageal reflux disease via pH monitoring: estimating budget impact on managed care organizations
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DOI：
10.1185/030079908x280680
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发表时间：
2008-05-01
影响因子：
2.3
通讯作者：
Pashos, C. L.
中科院分区：
文献类型：
--
作者：
Lee, W. C.;Yeh, Y. C.;Pashos, C. L.
背景：目前的指南建议使用pH监测来确认内镜检查正常的患者的酸反流诊断。本分析评估了财务影响的pH值监测与无线pH胶囊上的管理式医疗机构（MCO）在Uniteds.Methods：一个决策模型的构建项目总1年的成本，以管理GERD症状，并没有采用无线pH胶囊在一个假设的MCO与10 000名合格的成年登记者，其中600人与GERD样症状。评估了通过pH监测排除GERD诊断的患者的GERD诊断、治疗和症状管理费用。每个成员每月（PMPM）和每个治疗成员每月（PTMPM）的增量成本是主要结果。数据来源包括文献，专家输入，和标准化的费用schedule.Results：增加10个百分点，在使用pH值监测与无线pH胶囊产生增量PMPM和PTMPM的成本分别为0.029美元和0.481美元。该计划的质子泵抑制剂（PPI）治疗费用从238086美元降至236363美元，而pH监测（从16739美元增至21973美元）和非GERD治疗费用（从1392美元增至1740美元）则有所增加。结果是敏感的百分比，需要重复内窥镜检查前无线pH值监测和PPIS.Conclusions成本的患者：及时和增加使用pH值监测建议在出版的指南导致不必要的使用PPIs与适度的预算影响健康计划。
Background: Current guidelines recommend the use of pH monitoring to confirm the diagnosis of acid reflux in patients with a normal endoscopy. This analysis evaluated the financial impact of pH monitoring with the wireless pH capsule on a managed care organization (MCO) in the United States.Methods: A decision model was constructed to project total 1-year costs to manage GERD symptoms with and without the adoption of wireless pH capsules in a hypothetical MCO with 10 000 eligible adult enrollees, of whom 600 presented with GERD-like symptoms. Costs of GERD diagnosis, treatment, and symptom management for those in whom a GERD diagnosis was ruled out by pH monitoring were assessed. The incremental per-member-per-month (PMPM) and per-treated-member-per-month (PTMPM) costs were the primary outcomes. Data sources included literature, expert input, and standardized fee schedules.Results: An increase of 10 percentage points in the use of pH monitoring with wireless pH capsules yielded incremental PMPM and PTMPM costs of $0.029 and $0.481, respectively. The costs of proton pump inhibitor (PPI) therapy to the plan dropped to $236363 from $238 086, while increases were observed in pH monitoring (from $16739 to $21973) and non-GERD therapy costs (from $1392 to $1740). The results were sensitive to the percentage of patients requiring repeat endoscopy before wireless pH monitoring and the cost of PPIs.Conclusions: Timely and increased use of pH monitoring as recommended in published guidelines leads to less unnecessary use of PPIs with a modest budgetary impact on health plans.