An assessment of the use of costs and quality of life as outcomes in endoscopic research.
BACKGROUND
Costs and quality of life are increasingly important study outcomes. We quantitatively and qualitatively assessed their use in recent endoscopic research.


METHODS
All Medline-retrieved 1985 to 1995 published gastrointestinal endoscopic research using cost and/or quality of life as outcomes were analyzed.


RESULTS
Sixty-eight (1.2%) of an estimated 5568 publications discussed costs and/or quality of life as endoscopic outcomes (24 quality of life, 37 cost-effectiveness, 7 cost-benefit). Their use did not increase with time. Cost or quality of life was infrequently a primary study outcome. Twenty of 24 (83%) quality of life papers used an objective scale. However, of these, 15 of 20 (75%) used symptom indexes, performance scales, or other nonvalidated quality of life instruments. Two of 24 (8%) evaluated quality of life in nonmalignant disease. Eight of 40 (20%) papers claimed endoscopy was cost-effective, with no evidence of formal cost assessment. Ten of 32 (31%) substituted charges for costs. Of 21 papers reporting cost data, 4 (19%) specified cost type (e.g., direct vs other), 6 (29%) specified cost perspective, and 9 (43%) reported sensitivity analysis. Sixteen of 27 (59%) cost-effectiveness papers did not correlate costs with changes in a health outcome.


CONCLUSIONS
The overall cost and quality of life assessment in endoscopic research has been limited and must be improved. Accurate cost and quality of life assessment will require cooperation between gastroenterologists and experts in these fields.
Sahai
A V
AV
Digestive Disease Center, Medical University of South Carolina, Charleston 29425-2220, USA.
Pineault
R
R
D003362:Cost-Benefit Analysis; D016099:Endoscopy, Gastrointestinal / Q000191:economics*; D017048:Health Care Costs; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years