title: When does testing for GERD become cost effective in an integrated health network?
abstract: BACKGROUND
  Gastroesophageal reflux (GERD) is the most common gastrointestinal disorder, affecting as many as 14% of the US population. Rising rates of esophageal adenocarcinoma are seen in this population, and chronic proton pump inhibitor (PPI) use does not normalize cancer risk. It has also been demonstrated that up to one-third of patients on PPI therapy did not actually have GERD and could be taken off the medication. These facts form the basis for a quality-assurance study of care provided to patients in an integrated health care network who were on high-dose, long-term PPI therapy.
  
  
  METHODS
  A cost-benefit analysis of patients who were on double-dose PPI therapy for more than 6 months was performed. Pharmacy, facility, physician reimbursement, and radiologic data from a cohort who were both primary-care patients and insured in our system were utilized.
  
  
  RESULTS
  Two hundred and twenty-four patients were prescribed a double dose of this medication for over 6 months. Utilizing a 4.5% discount rate, our break-even analysis showed that Bravo testing [with esophagogastroduodenoscopy (EGD)] needed to identify those patients who could be taken off PPI therapy paid for itself in 33 months. Bravo + EGD + manometry testing needed to screen for other possible pathologies paid for itself in 38 months. Bravo + barium swallow + EGD testing to screen patients for possible esophageal adenocarcinoma paid for itself in 42 months. Bravo + barium swallow + manometry + EGD testing paid for itself in 47 months.
  
  
  CONCLUSIONS
  Significant savings can be realized through early use of upper endoscopy, Bravo testing, barium swallow, and manometry to identify patients that are taking double-dose PPIs unnecessarily based on presumptive diagnosis of GERD. This early testing also has the potential to diagnose a variety of other clinically important pathologic conditions more readily.
authors.affiliation: School of Medicine, Tufts University, Boston, MA, USA.
authors.forename: Anoop
authors.initials: A
authors.lastname: Raman
authors.forename: Joel
authors.initials: J
authors.lastname: Sternbach
authors.forename: Azeesat
authors.initials: A
authors.lastname: Babajide
authors.forename: Ketan
authors.initials: K
authors.lastname: Sheth
authors.forename: Steven D
authors.initials: SD
authors.lastname: Schwaitzberg
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D004305:Dose-Response Relationship, Drug; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal / Q000191:economics*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics; D006801:Humans; D008365:Manometry / Q000191:economics*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000191:economics; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014481:United States
chemical_list: D054328:Proton Pump Inhibitors