An economic analysis of an acid-reflux breath test in the evaluation of chronic cough

Abstract

Gastroesophageal reflux disease (GERD) is one of the most common causes of chronic cough. A new diagnostic breath test for acid-reflux cough may allow more rapid diagnosis. The economic impact of this test is incompletely characterized. We sought to evaluate the cost-effectiveness of a diagnostic breath test for acid-reflux cough, and to identify which testing characteristics are most important in a cost-effective approach to the problem of acid-reflux cough. Cohort simulations were used to compare direct costs of the acid-reflux breath test (ARBT) to an evidence-based clinical practice guideline (EBCPG) from a societal perspective over a one-year time horizon. Probabilities and costs were derived from the published literature and current US market conditions. Sensitivity analyses were performed. For all reasonable estimates of the prevalence of GERD causing cough, the most cost-effective diagnostic approach is to begin with the ARBT and initiate treatment with a proton-pump inhibitor (PPI) if the test is positive. Assuming a disease prevalence of 36%, this strategy costs $622 per case correctly diagnosed. The approaches demonstrated similar rates of correct diagnoses (92.1% versus 93.0%, ARBT versus EBPG). The EBPG algorithm costs $967 per correct diagnosis. ARBT became increasingly cost-effective at lower disease prevalence. When the prevalence of acid-reflux cough exceeded 80%, EBPG become economically favored. The acid-reflux breath test is the most affordable means of determining whether therapy directed at acid reflux is the correct course of action for management of chronic cough.