Capsule enteroscopy vs. other diagnostic procedures in diagnosing obscure gastrointestinal bleeding: a cost-effectiveness study.
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.
Marmo
Riccardo
R
Division of Gastroenterology, L.Curto Hospital, Polla, Sant'Arsenio, Italy. ricmarmo1@virgilio.it
Rotondano
Gianluca
G
Rondonotti
Emanuele
E
de Franchis
Roberto
R
D'Incà
Roberto
R
Vettorato
Maria Grazia
MG
Costamagna
Guido
G
Riccioni
Maria E
ME
Spada
Cristiano
C
D'Angella
Rosario
R
Milazzo
Giuseppe
G
Faraone
Antonio
A
Rizzetto
Mario
M
Barbon
Valeria
V
Occhipinti
Pietro
P
Saettone
Silvia
S
Iaquinto
Gaetano
G
Rossini
Francesco P
FP
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