title: The cost-effectiveness analysis of video capsule endoscopy compared to other strategies to manage acute upper gastrointestinal hemorrhage in the ED.
abstract: OBJECTIVE
  Acute upper gastrointestinal (GI) hemorrhage is a common presentation in hospital-based emergency departments (EDs). A novel diagnostic approach is to use video capsule endoscopy to directly visualize the upper GI tract and identify bleeding. Our objective was to evaluate and compare the relative costs and benefits of video capsule endoscopy compared to other strategies in low- to moderate-risk ED patients with acute upper GI hemorrhage.
  
  
  METHODS
  We constructed a model using standard decision analysis software to examine the cost-effectiveness of 4 available strategies for a base-case patient who presents to the ED with either mild- or moderate-risk scenarios (by Glasgow-Blatchford Score) for requiring invasive hemostatic intervention (ie, endoscopic, surgical, etc) The 4 available diagnostic strategies were (1) direct imaging with video capsule endoscopy performed in the ED; (2) risk stratification using the Glasgow-Blatchford score; (3) nasogastric tube placement; and, finally, (4) an admit-all strategy.
  
  
  RESULTS
  In the low-risk scenario, video capsule endoscopy was the preferred strategy (cost $5691, 14.69 quality-adjusted life years [QALYs]) and was more cost-effective than the remaining strategies including nasogastric tube strategy (cost $8159, 14.69 QALYs), risk stratification strategy (cost $10,695, 14.69 QALYs), and admit-all strategy (cost $22,766, 14.68 QALYs). In the moderate-risk scenario, video capsule endoscopy continued to be the preferred strategy (cost $9190, 14.56 QALYs) compared to nasogastric tube (cost $9487, 14.58 QALYs, incremental cost-effectiveness ratio $15,891) and more cost effective than admit-all strategy (cost, $22,584, 14.54 QALYs.)
  
  
  CONCLUSIONS
  Video capsule endoscopy may be cost-effective for low- and moderate-risk patients presenting to the ED with acute upper GI hemorrhage.
authors: Department of Emergency Medicine, George Washington University, Washington, DC, USA. Electronic address: ameltzer@mfa.gwu.edu.
authors: Andrew C
authors: AC
authors: Meltzer
authors: Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
authors: Michael J
authors: MJ
authors: Ward
authors: Bruce and Ruth Rappaport Faculty Of Medicine, Technion-Israel Institute Of Technology, GI Outcomes Unit, Department Of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
authors: Ian M
authors: IM
authors: Gralnek
authors: Department of Emergency Medicine, George Washington University, Washington, DC, USA.
authors: Jesse M
authors: JM
authors: Pines
mesh_terms: D000368:Aged; D053704:Capsule Endoscopy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000191:economics*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000191:economics; D006489:Hemostatic Techniques / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000191:economics; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment