Timely confirmation of gastroesophageal reflux disease via pH monitoring: Estimating budget impact on managed care organizations

Won Chan Lee, Y. C. Yeh, B. E. Lacy, J. E. Pandolfino, J. V. Brill, M. L. Weinstein, A. M. Carlson, M. J. Williams, M. R. Wittek, C. L. Pashos

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

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 $16 739 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.

Original languageEnglish (US)
Pages (from-to)1317-1327
Number of pages11
JournalCurrent Medical Research and Opinion
Volume24
Issue number5
DOIs
StatePublished - May 2008

Keywords

  • Budget impact model
  • Cost
  • GERD
  • Gastro-esophageal reflux disease
  • pH monitoring

ASJC Scopus subject areas

  • Medicine(all)

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