May 29, 2013
A Third of PPI Users May Have No Signs of GERD

Orlando, Florida—As many as a third of patients for whom pharmacists fill proton pump inhibitor (PPI) prescriptions may have no measurable signs of gastroesophageal reflux disease (GERD), according to a study presented recently at Digestive Disease Week.

A study by New York Presbyterian Hospital and Weill-Cornell Medical College suggests that some of those costs and risk factors could be avoided if more objective testing was used with GERD. The study employed a cost model created from a third-party payer perspective over a 10-year period.

GERD is thought to affect nearly 25% of adults, but researchers found that almost a third of patients undergoing treatment had no measurable signs of the chronic condition. Changing current diagnostic guidelines could save up to $7,300 per patient over 10 years, according to the presentation.

“Many patients remain on proton-pump inhibitors for years after the trial period without any confirmation that they are being treated for the right diagnosis,” said David Kleiman, MD, a research fellow in the department of surgery at New York Presbyterian Hospital. “A prompt pH monitoring test could help clinicians to accurately diagnosis GERD, increase healthy outcomes for patients and save people money.”

The study noted that the weekly cost of PPIs ranged from $29.06 to $107.70, and the cost of 24-hour pH monitoring was $690, adding that patients with esophageal and extra-esophageal GERD symptoms reported a median of 208 and 52 weeks of PPI use, respectively, prior to referral.

Most guidelines recommend an 8-week trial of PPIs to reduce acid secretion, with observation to see if symptoms subside. In the study, that approach was compared to 24-hour esophageal pH monitoring, in which a small tube is passed through the nose into the stomach. The tube is attached to a recorder worn at the belt to track acid levels.

Researchers noted that the study group was prescribed a total of 21,411 weeks of PPIs beyond the initial eight-week trial, “32% of which were for patients who had a negative 24-hour pH monitoring study and were therefore unnecessary.”

If the sensitivity of pH monitoring was 100%, they added, performing pH monitoring on all patients after an 8-week PPI trial would have saved between $1,966 and $7,285 per patient over 10 years. The strategy remains cost-effective as long as the sensitivity of pH monitoring is above 35%, according to the study.

“The misconceptions about pH monitoring are that it's unnecessary, expensive or too inconvenient,” Kleiman pointed out. “But, the benefits seen in our study show that pH monitoring should be strongly considered.”

Kleiman suggested that patients be considered for pH monitoring immediately after their 8-week PPI trial.

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