Health economics evaluation of diagnostic strategies for gastro-oesophageal reflux disease with reflux symptoms in China: a modelling study

OBJECTIVES: American College of Gastroenterology (ACG) and Chinese expert consensus recommended different algorithmic approaches for the diagnosis of gastro-oesophageal reflux disease (GERD) are not yet defined. We compared the two recommended diagnostic processes using a Chinese population-based health economics analysis. METHODS: Our analysis considered a hypothetical cohort of patients with typical reflux symptoms. We constructed a decision tree model to compare the two recommended diagnostic processes described in ACG clinical guidelines (stratified endoscopy strategy) and Chinese expert consensus (endoscopy-first strategy). The first strategy begins with hazard stratification based on alarm symptoms. Patients with alarm symptoms directly undergo endoscopic examination, while patients without alarm symptoms receive proton pump inhibitors as diagnostic treatment. In the second strategy, all patients with reflux symptoms complete an endoscopic examination. Sensitivity analysis was performed to evaluate a range of cost and probability estimates on costs and health outcomes over a 1-year time horizon from the healthcare system perspective. RESULTS: The total expected costs were US$122.51 for the stratified endoscopy strategy and US$150.12 for the endoscopy-first strategy. The incremental cost-effectiveness ratio (ICER) comparing the endoscopy-first strategy with the stratified endoscopy strategy was US$440.39 per additional correct case of GERD. The rates of detecting upper gastrointestinal carcinoma of the two strategies were 0.0088 and 0.0120, and the ICER was US$8561.34. CONCLUSIONS: The use of endoscopy for all patients with reflux symptoms was more effective but with an increased cost compared with the strategy recommended in international guidelines.