EMPIRICAL THERAPY VERSUS DIAGNOSTIC-TESTS IN GASTROESOPHAGEAL REFLUX DISEASE - A MEDICAL DECISION-ANALYSIS

Our objective was to describe the conditions that determine the costs of empirical therapy in gastroesophageal reflux disease (GERD). Our de sign was a threshold analysis using a decision tree, The costs of medi cations were estimated from the average wholesale prices. The costs of diagnostic procedures were expressed as the sum of physician and faci lity costs. A decision tree was modeled to calculate the threshold pro bability of GERD, for which empirical therapy became the preferred man agement strategy. Bayes' formula was used to transform the sensitivity and specificity of various symptoms and the joint occurrence of multi ple symptoms into disease probabilities. The decision in favor of empi rical therapy is influenced by four factors: the probability of GERD, the duration or costs of GERD therapy, the costs of erroneous empirica l therapy in patients with diagnosis other than GERD, and the costs of diagnostic procedures. In general, the expected benefit of saving the costs of a diagnostic procedure outweighs the costs of occasional err oneous empirical therapy. How ever, if surgical therapy is considered or antisecretory therapy is administered for a time period of 10 or mo re years, diagnostic confirmation of GERD should be sought. In the lon g run, the failure to differentiate between peptic ulcer and GERD resu lts in the highest cost associated with erroneous empirical therapy. I n patients with multiple characteristic symptoms of GERD, the diagnosi s can be ascertained with sufficient confidence to warrant empirical t herapy.