An assessment of the potential value of endoscopic ultrasound as a cost-minimizing tool in dyspeptic patients with persistent symptoms.
OBJECTIVE
To quantify resource utilization in dyspeptic patients with persistent symptoms and to determine whether using both the endoscopic and ultrasound capabilities of endoscopic ultrasound could reduce costs.


METHODS
Consecutive patients with persistent dyspepsia, after a minimum 1-month trial of acid suppression, underwent endoscopic ultrasound (EUS) and upper endoscopy using the GF-UM20 echo endoscope. Assuming EUS could replace imaging tests which had been requested in addition to upper endoscopy, the hypothetical costs of the EUS-based and upper endoscopy-based strategies were compared.


RESULTS
116 patients with persistent dyspepsia underwent EUS, of whom 64.6 % had > or = 2 imaging procedures, most commonly computed tomography (CT) (70.6 %) and abdominal ultrasound (64.7 %). The number of tests did not correlate strongly with any demographic variables. The fiberoptic echo endoscope provided an adequate endoscopic and ultrasound examination but was damaged by retroflexion. Direct hospital costs were lowest for the EUS-based strategy. Total avoidable cost for 116 patients was $ 4137 to $ 14 121 (or $ 36 to $ 122 per patient), depending on whether upper endoscopy was performed in the non-EUS strategies.


CONCLUSIONS
Patients with persistent dyspepsia may undergo multiple abdominal imaging procedures. Clinical variables do not predict the need for additional testing. An EUS-based strategy may reduce overall costs if it prevents additional testing.
Sahai
A V
AV
Division of Gastroenterology and Hepatology/Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA. anand.sahai@sympaticos.ca
Penman
I D
ID
Mishra
G
G
Williams
D
D
Pearson
A
A
Wallace
M B
MB
van Velse
A
A
Hoffman
B J
BJ
Hawes
R H
RH
D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D004415:Dyspepsia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016099:Endoscopy, Gastrointestinal / Q000191:economics; D019160:Endosonography / Q000191:economics*; D005251:Fees, Medical; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies