title: BRAVO esophageal pH monitoring: more cost-effective than empiric medical therapy for suspected gastroesophageal reflux.
abstract: 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.
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 294, New York, NY, 10065, USA. cha9043@med.cornell.edu.
authors.forename: Cheguevara
authors.initials: C
authors.lastname: Afaneh
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 294, New York, NY, 10065, USA.
authors.forename: Veronica
authors.initials: V
authors.lastname: Zoghbi
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 294, New York, NY, 10065, USA.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Finnerty
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 294, New York, NY, 10065, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Aronova
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 294, New York, NY, 10065, USA.
authors.forename: David
authors.initials: D
authors.lastname: Kleiman
authors.affiliation: Department of Pediatrics, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, 10065, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ciecierega
authors.affiliation: Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, 10065, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Crawford
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 294, New York, NY, 10065, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fahey
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 294, New York, NY, 10065, USA.
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D050782:Esophageal pH Monitoring / Q000191:economics* / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D013686:Telemetry / Q000191:economics*; D059015:Wireless Technology / Q000191:economics*; D055815:Young Adult
keywords: BRAVO; Empiric therapy; Gastroesophageal reflux disease; Proton-pump inhibitor; Wireless pH monitoring