| Abstract: | Our objective was to describe the conditionsthat determine the costs of empirical therapy ingastroesophageal reflux disease (GERD). Our design wasa threshold analysis using a decision tree. The costs of medications were estimated from the averagewholesale prices. The costs of diagnostic procedureswere expressed as the sum of physician and facilitycosts. A decision tree was modeled to calculate the threshold probability of GERD, for whichempirical therapy became the preferred managementstrategy. Bayes' formula was used to transform thesensitivity and specificity of various symptoms and thejoint occurrence of multiple symptoms into diseaseprobabilities. The decision in favor of empiricaltherapy is influenced by four factors: the probabilityof GERD, the duration or costs of GERD therapy, the costs of erroneous empirical therapy inpatients with diagnosis other than GERD, and the costsof diagnostic procedures. In general, the expectedbenefit of saving the costs of a diagnostic procedureoutweighs the costs of occasional erroneous empiricaltherapy. However, if surgical therapy is considered orantisecretory therapy is administered for a time periodof 10 or more years, diagnostic confirmation of GERD should be sought. In the long run, thefailure to differentiate between peptic ulcer and GERDresults in the highest cost associated with erroneousempirical therapy. In patients with multiplecharacteristic symptoms of GERD, the diagnosis can beascertained with sufficient confidence to warrantempirical therapy. |
