Cost–Utility Analysis of Wireless Versus Catheter‐Based Oesophageal pH Monitoring in the Pre‐Operative Assessment of Anti‐Reflux Surgery: A Decision‐Analytic Model

ABSTRACT 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.