C22COST-EFFECTIVENESS OF ALTERNATIVE DIAGNOSIS

StudyYearCountrySettingFollow-upDesignPopulationInterventionComparatorOutcomes
Spiegel2004USAModel based10-year model horizonDecision analysisRome II, IBS-D, no evidence of alternative organic diagnosesScreen for coeliac disease and initiate IBS or coeliac treatment accordinglyInitiate IBS treatment without screening for coeliac diseaseCost per additional symptomatic improvement
Mein2004USAModel basedLifetime horizon (from age 35)Decision analysisSuspected IBSTTG* test or antibody panel± or endoscopyNo testingCost per QALY, cost per case detected
Suleiman2001USAModel basedNot statedDecision analysisSuspected IBSAlternative sequencing for endoscopy in diagnostic testing strategiesN/ACost per % increase in cumulative probability of IBS diagnosis, cost per correct diagnosis
Dubinsky2002USAModel based1 year model horizonDecision analysisIBD symptoms not meeting
Rome criteria for IBS
Single or sequential serological tests followed by gold standardGold standard aloneCost per patient assessed, accuracy (%correctly diagnosed as IBD or non-IBS), cost per marginal increase in accuracy.
*

TTG, tissue transglutaminase antibody;

±

antibody panel, TTG plus antiglandin IgG and IgA plus quantitative IgA to exclude IgA deficiency

From: Appendix C, Characteristics of included studies

Cover of Irritable Bowel Syndrome in Adults
Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care [Internet].
NICE Clinical Guidelines, No. 61.
National Collaborating Centre for Nursing and Supportive Care (UK).
Copyright © 2008, Royal College of Nursing.

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