PMID- 18377705
OWN - NLM
STAT- MEDLINE
DCOM- 20080722
LR  - 20190911
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 24
IP  - 5
DP  - 2008 May
TI  - Timely confirmation of gastro-esophageal reflux disease via pH monitoring: 
      estimating budget impact on managed care organizations.
PG  - 1317-27
AB  - 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 $236,363 from $238,086, while increases were 
      observed in pH monitoring (from $16 739 to $21 973) 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.
FAU - Lee, W C
AU  - Lee WC
AD  - HERQuLES, Abt Associates Inc. Bethesda, MD 20814-3343, USA. 
      WonChan_Lee@abtassoc.com
FAU - Yeh, Y C
AU  - Yeh YC
FAU - Lacy, B E
AU  - Lacy BE
FAU - Pandolfino, J E
AU  - Pandolfino JE
FAU - Brill, J V
AU  - Brill JV
FAU - Weinstein, M L
AU  - Weinstein ML
FAU - Carlson, A M
AU  - Carlson AM
FAU - Williams, M J
AU  - Williams MJ
FAU - Wittek, M R
AU  - Wittek MR
FAU - Pashos, C L
AU  - Pashos CL
LA  - eng
PT  - Journal Article
DEP - 20080327
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
RN  - 0 (Enzyme Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Proton Pumps)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Budgets
MH  - *Cost of Illness
MH  - Cost-Benefit Analysis
MH  - Enzyme Inhibitors/administration & dosage/economics
MH  - Esophageal pH Monitoring/*economics/instrumentation
MH  - Esophagoscopy/economics
MH  - Female
MH  - Gastroesophageal Reflux/*diagnosis/drug therapy/*economics
MH  - Humans
MH  - Male
MH  - Managed Care Programs/economics/*organization & administration
MH  - Middle Aged
MH  - Models, Economic
MH  - Predictive Value of Tests
MH  - *Proton Pump Inhibitors
MH  - Proton Pumps/economics
MH  - Risk Assessment
MH  - United States
EDAT- 2008/04/02 09:00
MHDA- 2008/07/23 09:00
CRDT- 2008/04/02 09:00
PHST- 2008/04/02 09:00 [pubmed]
PHST- 2008/07/23 09:00 [medline]
PHST- 2008/04/02 09:00 [entrez]
AID - 4322 [pii]
AID - 10.1185/030079908x280680 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2008 May;24(5):1317-27. doi: 10.1185/030079908x280680. Epub 
      2008 Mar 27.