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Cost-effectiveness analysis of management strategies for obscure GI bleeding.
Gastrointest Endosc. 2008 Nov; 68(5):920-36.GE

Abstract

BACKGROUND AND AIMS

Of patients who are seen with GI hemorrhage, approximately 5% will have a small-bowel source. Management of these patients entails considerable expense. We performed a decision analysis to explore the optimal management strategy for obscure GI hemorrhage.

METHODS

We used a cost-effectiveness analysis to compare no therapy (reference arm) to 5 competing modalities for a 50-year-old patient with obscure overt bleeding: (1) push enteroscopy, (2) intraoperative enteroscopy, (3) angiography, (4) initial anterograde double-balloon enteroscopy (DBE) followed by retrograde DBE if the patient had ongoing bleeding, and (5) small-bowel capsule endoscopy (CE) followed by DBE guided by the CE findings. The model included prevalence rates for small-bowel lesions, sensitivity for each intervention, and the probability of spontaneous bleeding cessation. We examined total costs and quality-adjusted life years (QALY) over a 1-year time period.

RESULTS

An initial DBE was the most cost-effective approach. The no-therapy arm cost $532 and was associated with 0.870 QALYs compared with $2407 and 0.956 QALYs for the DBE approach, which resulted in an incremental cost-effectiveness ratio of $20,833 per QALY gained. Compared to the DBE approach, an initial CE was more costly and less effective. The initial DBE arm resulted in an 86% bleeding cessation rate compared to 76% for the CE arm and 59% for the no-therapy arm. The model results were robust to a wide range of sensitivity analyses.

LIMITATIONS

The short time horizon of the model, because of the lack of long-term data about the natural history of rebleeding from small-intestinal lesions.

CONCLUSIONS

An initial DBE is a cost-effective approach for patients with obscure bleeding. However, capsule-directed DBE may be associated with better long-term outcomes because of the potential for fewer complications and decreased utilization of endoscopic resources.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology Stanford University School of Medicine, Stanford, California 94305-5202, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18407270

Citation

Gerson, Lauren, and Ahmad Kamal. "Cost-effectiveness Analysis of Management Strategies for Obscure GI Bleeding." Gastrointestinal Endoscopy, vol. 68, no. 5, 2008, pp. 920-36.
Gerson L, Kamal A. Cost-effectiveness analysis of management strategies for obscure GI bleeding. Gastrointest Endosc. 2008;68(5):920-36.
Gerson, L., & Kamal, A. (2008). Cost-effectiveness analysis of management strategies for obscure GI bleeding. Gastrointestinal Endoscopy, 68(5), 920-36. https://doi.org/10.1016/j.gie.2008.01.035
Gerson L, Kamal A. Cost-effectiveness Analysis of Management Strategies for Obscure GI Bleeding. Gastrointest Endosc. 2008;68(5):920-36. PubMed PMID: 18407270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness analysis of management strategies for obscure GI bleeding. AU - Gerson,Lauren, AU - Kamal,Ahmad, Y1 - 2008/04/14/ PY - 2007/07/18/received PY - 2008/01/17/accepted PY - 2008/4/15/pubmed PY - 2009/4/10/medline PY - 2008/4/15/entrez SP - 920 EP - 36 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 68 IS - 5 N2 - BACKGROUND AND AIMS: Of patients who are seen with GI hemorrhage, approximately 5% will have a small-bowel source. Management of these patients entails considerable expense. We performed a decision analysis to explore the optimal management strategy for obscure GI hemorrhage. METHODS: We used a cost-effectiveness analysis to compare no therapy (reference arm) to 5 competing modalities for a 50-year-old patient with obscure overt bleeding: (1) push enteroscopy, (2) intraoperative enteroscopy, (3) angiography, (4) initial anterograde double-balloon enteroscopy (DBE) followed by retrograde DBE if the patient had ongoing bleeding, and (5) small-bowel capsule endoscopy (CE) followed by DBE guided by the CE findings. The model included prevalence rates for small-bowel lesions, sensitivity for each intervention, and the probability of spontaneous bleeding cessation. We examined total costs and quality-adjusted life years (QALY) over a 1-year time period. RESULTS: An initial DBE was the most cost-effective approach. The no-therapy arm cost $532 and was associated with 0.870 QALYs compared with $2407 and 0.956 QALYs for the DBE approach, which resulted in an incremental cost-effectiveness ratio of $20,833 per QALY gained. Compared to the DBE approach, an initial CE was more costly and less effective. The initial DBE arm resulted in an 86% bleeding cessation rate compared to 76% for the CE arm and 59% for the no-therapy arm. The model results were robust to a wide range of sensitivity analyses. LIMITATIONS: The short time horizon of the model, because of the lack of long-term data about the natural history of rebleeding from small-intestinal lesions. CONCLUSIONS: An initial DBE is a cost-effective approach for patients with obscure bleeding. However, capsule-directed DBE may be associated with better long-term outcomes because of the potential for fewer complications and decreased utilization of endoscopic resources. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/18407270/Cost_effectiveness_analysis_of_management_strategies_for_obscure_GI_bleeding_ DB - PRIME DP - Unbound Medicine ER -