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Am J Emerg Med. 2014 Aug;32(8):823-32. doi: 10.1016/j.ajem.2013.11.012. Epub 2013 Nov 13.

The cost-effectiveness analysis of video capsule endoscopy compared to other strategies to manage acute upper gastrointestinal hemorrhage in the ED.

Author information

1
Department of Emergency Medicine, George Washington University, Washington, DC, USA. Electronic address: ameltzer@mfa.gwu.edu.
2
Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
3
Bruce and Ruth Rappaport Faculty Of Medicine, Technion-Israel Institute Of Technology, GI Outcomes Unit, Department Of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
4
Department of Emergency Medicine, George Washington University, Washington, DC, USA.

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.

PMID:
24961149
PMCID:
PMC4108573
DOI:
10.1016/j.ajem.2013.11.012
[Indexed for MEDLINE]
Free PMC Article
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