Monitoring Heartburn and the Wallet

GERD pH monitoring referral more cost effective than proton pump inhibitor use long term

(RxWiki News) While heart burn pains the chest, the costs of certain medicines to ease that pain can shrink the pocket book over time. A method that keeps an eye on reflux symptoms could save patients' cash.

New research presented at a conference found that patients with gastroesophageal reflux disease (GERD) who took a pH test after short-term medicine use to monitor their symptoms saved more money than patients who only took medicines long-term.

A 24-hour esophageal pH monitoring test measures how often stomach acid enters the esophagus, the tube connecting the mouth to the stomach.

Though the findings are still preliminary, they show that the costs for taking proton-pump inhibitors (PPIs), which are medicines that limit stomach acid from forming, surpassed the cost of pH monitoring.

"Ask your doctor about the costs of pH monitoring."

Individuals with GERD, or acid reflux, often take PPIs to ease their symptoms. In GERD, food or liquid contents from the stomach leak back into the esophagus which can cause pain and heartburn.

David Kleiman, MD, a research fellow in the Department of Surgery at New York Presbyterian Hospital and Weill Cornell Medical College in New York, led a team of researchers in investigating what techniques were more cost-effective in monitoring GERD symptoms.

They looked at the cost difference between patients who had pH monitoring after an eight-week period on PPIs compared to patients who took the PPIs over a prolonged period of time.

The researchers compared the price of a low-end generic brand PPI with that of a high-end name brand PPI. Costs were acquired through the 2012 Micromedex Redbook.

The low-end PPI contained 20 milligrams of the active ingredient while the high-end PPI contained twice as much of the ingredient.

To measure cost-effectiveness, the cost of unnecessary PPIs was subtracted from the cost of pH monitoring. The procedure involves a small capsule that's attached to the lining of the esophagus to measure and record pH levels between one and two days.

Costs for testing pH levels and tests to measure how well the esophagus functioned over a 24-hour period were also tracked. 

The study included 100 patients who underwent pH monitoring. The researchers noted patients' GERD symptoms and how long they used the PPIs prior to being monitored.

Participants were prescribed a total of 21,411 weeks of PPIs beyond the initial eight-week trial. Almost a third of these patients had a negative 24-hour pH monitoring study.

Weekly costs for PPIs ranged from $29.06 to $107.70, the researchers found. And the cost of 24-hour pH monitoring was $690.

If pH monitor was 100 percent accurate, the researchers also found that performing pH monitoring on all patients after an eight-week PPI trial would have saved between $1,966 and $7,285 per patient over a decade.

The researchers found that the strategy would continue to be cost-effective as long as the sensitivity of the pH monitoring, which is how accurate the monitoring system works, is above 35 percent.

Depending on the type of PPI medication, the cost of using a PPI equals the cost of pH monitoring after 6.4 to 23.7 weeks.

"Most patients are maintained on PPIs for periods greatly surpassing the cost-equivalence point with 24-hour esophageal pH monitoring," the researchers wrote in their report. "Early referral for pH monitoring after a brief empiric PPI trial may result in substantial cost savings for patients with both esophageal and extra-esophageal GERD symptoms."

The study, which has not yet been published, was presented May 18 during Digestive Disease Week in Florida.

One of the authors was a consultant for Abbott, Salix Pharmaceuticals and Shire Pharmaceuticals Inc. He also received grant and research support from Centocor. The other authors declare no conflicts of interest.

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Review Date: 
May 22, 2013