The cost-effectiveness analysis of video capsule endoscopy compared to other strategies to manage acute upper gastrointestinal hemorrhage in the ED - 29/07/14
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Abstract |
Study 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.)
Conclusion |
Video capsule endoscopy may be cost-effective for low- and moderate-risk patients presenting to the ED with acute upper GI hemorrhage.
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☆ | Source of support: investigator-initiated grant from Given Imaging, Ltd. Dr Ward was supported by a research fellowship from the Emergency Medicine Foundation and a K12 grant from the National Heart Lung and Blood Institute (K12HL109019). |
☆☆ | Author contributions: All authors (ACM, IMG, MJW, JMP) contributed significantly to study conception, data analysis, and manuscript preparation including writing and editing for this piece of scholarship. |
★ | Meetings: To be presented at the American College of Emergency Physicians Scientific Assembly. October 2013, Seattle, WA. |
Vol 32 - N° 8
P. 823-832 - août 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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