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Ann Intern Med. 2002 Jan 15;136(2):99-110.

Initial evaluation of rectal bleeding in young persons: a cost-effectiveness analysis.

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1
Center for Clinical Epidemiology and Biostatistics, Blockley Hall, 9th Floor, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA.

Abstract

BACKGROUND:

Evaluation of rectal bleeding in young patients is a frequent diagnostic challenge.

OBJECTIVE:

To determine the relative cost-effectiveness of alternative diagnostic strategies for young patients with rectal bleeding.

DESIGN:

Cost-effectiveness analysis using a Markov model.

DATA SOURCES:

Probability estimates were based on published medical literature. Cost estimates were based on Medicare reimbursement rates and published medical literature.

TARGET POPULATION:

Persons 25 to 45 years of age with otherwise asymptomatic rectal bleeding.

TIME HORIZON:

The patient's lifetime.

PERSPECTIVE:

Modified societal perspective.

INTERVENTIONS:

Diagnostic strategies included no evaluation, colonoscopy, flexible sigmoidoscopy, barium enema, anoscopy, or any feasible combination of these procedures.

OUTCOME MEASURES:

Life expectancy and costs.

RESULTS OF BASE-CASE ANALYSIS:

For 35-year-old patients, the no-evaluation strategy yielded the least life expectancy. The incremental cost-effectiveness of flexible sigmoidoscopy compared with no evaluation or with any strategy incorporating anoscopy (followed by further evaluation if no anal disease was found on anoscopy) was less than $5300 per year of life gained. A strategy of flexible sigmoidoscopy plus barium enema yielded the greatest life expectancy, with an incremental cost of $23 918 per additional life-year gained compared with flexible sigmoidoscopy alone.

RESULTS OF SENSITIVITY ANALYSIS:

As patient age at presentation of rectal bleeding increased, evaluation of the entire colon became more cost-effective. The incremental cost-effectiveness of flexible sigmoidoscopy plus barium enema compared with colonoscopy was sensitive to estimates of the sensitivity of the tests. In a probabilistic sensitivity analysis comparing flexible sigmoidoscopy with anoscopy followed by flexible sigmoidoscopy if needed, the middle 95th percentile of the distribution of the incremental cost-effectiveness ratios ranged from flexible sigmoidoscopy yielding an increased life expectancy at reduced cost to $52 158 per year of life gained (mean, $11 461 per year of life saved).

CONCLUSIONS:

Evaluation of the colon of persons 25 to 45 years of age with otherwise asymptomatic rectal bleeding increases the life expectancy at a cost comparable to that of colon cancer screening.

PMID:
11790061
[Indexed for MEDLINE]
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