当前位置： SCI文献检索 > GASTROINTESTINAL ENDOSCOPY期刊下所有文献 > Cost-effectiveness analysis of management strategies for obscure GI bleeding.

Cost-effectiveness analysis of management strategies for obscure GI bleeding.

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.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Gerson L,Kamal A

doi

10.1016/j.gie.2008.01.035

subject

Has Abstract

pub_date

2008-11-01 00:00:00

pages

920-36

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(08)00162-4

journal_volume

pub_type

杂志文章

在线工具

Cost-effectiveness analysis of management strategies for obscure GI bleeding.