ANZ journal of surgery · 2026
Cost-Utility Analysis of Wireless Versus Catheter-Based Oesophageal pH Monitoring in the Pre-Operative Assessment of Anti-Reflux Surgery: A Decision-Analytic Model.
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Phan Du H, Moy Naomi, Thomson Iain G, Frankel Adam J
Аннотация
BACKGROUND: Distal oesophageal pH testing is an important component of the pre-operative workup for anti-reflux surgery, providing diagnostic confirmation and prognostic information. Catheter-based reflux testing is currently the standard modality in Australia. Although associated with improved patient tolerability, wireless testing remains limited by access and funding restrictions.
METHODS: A cost-utility analysis was conducted to compare the cost-effectiveness of wireless versus catheter-based reflux monitoring before anti-reflux surgery. Health service costs (administrative, labour, and equipment) and EuroQol 5-Dimension-derived utility weights were used to calculate incremental costs per quality-adjusted life-year (QALY) over a one-year time horizon.
RESULTS: Wireless pH monitoring was associated with marginally lower costs and higher QALYs compared with catheter-based monitoring (AUD $11001.51 vs. AUD $11210.47; 0.87 vs. 0.82 QALYs). The base-case incremental cost-effectiveness ratio was -AUD $5026.64 per QALY, indicating that wireless monitoring was the dominant strategy. At a willingness-to-pay threshold of AUD $50 000 per QALY, the incremental net monetary benefit was AUD $2287.47, indicating potential cost-effectiveness. One-way sensitivity analyses suggested that base-case findings were robust across key parameter variations.
CONCLUSION: Within this model evaluating the pH testing component of the pre-operative work-up, wireless monitoring may represent a cost-effective alternative to catheter-based monitoring without substantially increasing healthcare costs.
METHODS: A cost-utility analysis was conducted to compare the cost-effectiveness of wireless versus catheter-based reflux monitoring before anti-reflux surgery. Health service costs (administrative, labour, and equipment) and EuroQol 5-Dimension-derived utility weights were used to calculate incremental costs per quality-adjusted life-year (QALY) over a one-year time horizon.
RESULTS: Wireless pH monitoring was associated with marginally lower costs and higher QALYs compared with catheter-based monitoring (AUD $11001.51 vs. AUD $11210.47; 0.87 vs. 0.82 QALYs). The base-case incremental cost-effectiveness ratio was -AUD $5026.64 per QALY, indicating that wireless monitoring was the dominant strategy. At a willingness-to-pay threshold of AUD $50 000 per QALY, the incremental net monetary benefit was AUD $2287.47, indicating potential cost-effectiveness. One-way sensitivity analyses suggested that base-case findings were robust across key parameter variations.
CONCLUSION: Within this model evaluating the pH testing component of the pre-operative work-up, wireless monitoring may represent a cost-effective alternative to catheter-based monitoring without substantially increasing healthcare costs.