title: Capsule enteroscopy vs. other diagnostic procedures in diagnosing obscure gastrointestinal bleeding: a cost-effectiveness study.
abstract: BACKGROUND
  Capsule enteroscopy is considered the gold standard for evaluating patients with obscure gastrointestinal bleeding. The costs of capsule enteroscopy examination, however, make it uncertain whether the clinically relevant diagnostic gain is also associated with cost savings.
  
  
  OBJECTIVE
  To evaluate the incremental cost-effectiveness ratio of capsule enteroscopy in patients with obscure gastrointestinal bleeding.
  
  
  METHODS
  Retrospective study was carried out in nine Italian gastroenterology units from 2003 to 2005. Data on 369 consecutive patients with obscure gastrointestinal bleeding were collected. The diagnostic yield of capsule enteroscopy vs. other imaging procedures was evaluated as a measure of efficacy. The values of Diagnosis Related Group 175 (euro 1884.00 for obscure-occult bleeding and euro 2141.00 for obscure-overt bleeding) were calculated as measures of economic outcomes in the cost analysis.
  
  
  RESULTS
  Obscure and occult gastrointestinal bleeding was recorded in 177 patients (48%) with a mean duration of anemia history of 17.6+/-20.7 months. Among patients, 60.9% had had at least one hospital admission, 21.2% at least two, and 1.2% of obscure bleeders up to nine admissions. Overall, 58.4% of patients had positive findings with capsule enteroscopy compared with 28.0% with other imaging procedures (P<0.001). The mean cost of a positive diagnosis with capsule enteroscopy was euro 2090.76 and that of other procedures was euro 3828.83 with a mean cost saving of euro 1738.07 (P<0.001) for one positive diagnosis.
  
  
  CONCLUSIONS
  Capsule enteroscopy is a cost-saving approach in the evaluation of patients with obscure gastrointestinal bleeding.
authors.affiliation: Division of Gastroenterology, L.Curto Hospital, Polla, Sant'Arsenio, Italy. ricmarmo1@virgilio.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marmo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rotondano
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rondonotti
authors.forename: Roberto
authors.initials: R
authors.lastname: de Franchis
authors.forename: Roberto
authors.initials: R
authors.lastname: D'Incà
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Vettorato
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.forename: Maria E
authors.initials: ME
authors.lastname: Riccioni
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spada
authors.forename: Rosario
authors.initials: R
authors.lastname: D'Angella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Milazzo
authors.forename: Antonio
authors.initials: A
authors.lastname: Faraone
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
authors.forename: Valeria
authors.initials: V
authors.lastname: Barbon
authors.forename: Pietro
authors.initials: P
authors.lastname: Occhipinti
authors.forename: Silvia
authors.initials: S
authors.lastname: Saettone
authors.forename: Gaetano
authors.initials: G
authors.lastname: Iaquinto
authors.forename: Francesco P
authors.initials: FP
authors.lastname: Rossini
mesh_terms: D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000191:economics* / Q000379:methods; D017046:Cost Savings / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000191:economics; D006471:Gastrointestinal Hemorrhage / Q000191:economics / Q000209:etiology*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D012189:Retrospective Studies