A Cost Analysis of the Diagnostic Workup of heartburn Symptoms in Patients with Erosive and Non-Erosive Reflux Disease

Abstract

Purpose: Gastroesophageal Reflux Disease (GERD) is the most common cause of outpatient visits to gastroenterology clinics in the United States. While many studies have examined the epidemiologic differences between patients with Non-Erosive Reflux Disease (NERD) and Erosive Esophagitis (EE), very few have compared the utilization of health care resources in these two patient groups. Our goals were: 1) Compare the costs of the diagnostic workup for heartburn symptoms in patients with NERD and EE 2) Identify the key areas which account for disparities in health care costs. Methods: A chart review was performed on 122 patients who underwent upper endoscopy for heartburn symptoms at the San Diego Veterans' Affairs Hospital from 2000–2007. Patients were then divided into two categories: 1) EE based upon the presence of esophageal erosions on upper endoscopy (N = 56) 2) NERD based upon the absence of endoscopic erosions (N = 66). Using cost data, we then calculated the per patient cost of performing a diagnostic workup for heartburn symptoms in these two patient groups. Results: There were no significant differences in the age, gender, BMI or the presence of hiatal hernia in the two groups (Table 1). 54% of the NERD group had a concomitant psychiatric disorder compared with 37.5% in EE (P= 0.03). The cost of the diagnostic workup for NERD was $2793.26 per patient compared with $2091.00 per patient in the EE group (P= 0.027). While the utilization of endoscopy was similar in both groups, utilization of GI clinic visits, pH/motility testing, and diagnostic imaging was greater among patients with NERD (Fig. 1). Overall, pH/motility testing and GI clinic visits accounted for 40% and 51% respectively of the extra costs found in the NERD group.FigureTable 1: Patient Characteristics.Conclusion: Health care utilization is greater in NERD than in EE. This may be a consequence of the fact that patients with NERD have a lower response rate to PPI therapy, thus prompting more frequent clinic visits. In addition, the over-utilization of motility/pH testing and diagnostic imaging in NERD may also drive up costs. The increased rate of co-morbid psychiatric disease in NERD raises the possibility that somatization may lead to the increased use of health care resources.