Introduction 24 hour pH-impedance reflux monitoring is considered the gold standard in diagnosing pathological gastroesophageal reflux (GOR). Alternative method is catheter-free Bravo capsules (96 hours). To date, their cost-effectiveness has yet to be compared. At Guy’s Hospital, London, UK, the cost of Bravo is estimated to be £1,200 (including endoscopy) and pH-impedance to be £800 (including high resolution manometry). It is generally assumed that the higher cost of Bravo monitoring is justifiable as it is thought to have a higher diagnostic yield due to better patient compliance and a longer monitoring time.
Methods Patients who had a Bravo or pH-impedance study during May-November 2015 were selected. The more cost-effective method was defined as the technique with lower cost (including cost of non-diagnostic results) per diagnostic procedure. To identify non-diagnostic results, the patients with pathological GOR, patients with positive symptom-reflux associations, patients with supragastric belching and patients who were adequately symptomatic (therefore having negative symptom-reflux association) were removed. Positive symptom-reflux association was considered as symptom association probability (SAP) ≥95% and/or symptom index (SI) ≥50%.
Results 81 Bravo patients and 145 pH-impedance patients were analysed. 50 (61.7%) Bravo patients and 69 (47.5%) pH-impedance patients were diagnosed with pathological GOR, 14 (17.3%) Bravo and 44 (30.3%) pH-impedance patients had hypersensitive oesophagus, 3 (2.1%) pH-impedance were patients diagnosed with supragastric belching causing symptoms, and 10 (12.3%) Bravo and 14 (9.7%) pH-impedance patients experienced symptoms unexplained by reflux events (negative symptom-reflux association). The remaining 7 (8.6%) Bravo and 15 (10.3%) pH-impedance entries therefore represent the proportion of non-diagnostic investigations. Cost calculations revealed that each Bravo with diagnostic yield costs £1313.5 whilst each pH-impedance with diagnostic yield costs £892.3 (Table 1). This means that for each diagnosis made by Bravo there is an additional cost of £421.2.
Conclusion The cost-effectiveness of pH-impedance reflux monitoring seems to be superior to Bravo system to make a reflux-related diagnosis. However, this study does not take into account other advantages of each method in clinical use.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.