Study identifies double-balloon enteroscopy as cost-effective approach for obscure G...(ions. The analysis was performed fro...),Health

The analysis was performed from a third-party payer perspective over a one-year time horizon. Facility and professional fees were based on Medicare allowable payments for rural and urban areas for four major markets in the U.S. (Calif., Ill., NY and Ga.). Costs of inpatient hospital services were obtained by using the 2005 Medicare Prospective Payment System diagnosis related group. Only direct health care costs were considered and did not account for the cost of non-health care expenditures such as transportation or time lost from work.

The primary focus of the analysis was cost per quality-adjusted life-years (QALY). The QALY is a number ranging between zero to one, where zero represents the state of death, and one a condition of perfect health. In order to generate a QALY value associated with a particular condition, in this case chronic gastrointestinal bleeding, patients with the condition can be interviewed. Patients are asked how many years or months of their projected life expectancy they would trade in order to achieve perfect health. The QALY is calculated as the current amount of years remaining according to U.S. life tables for a particular individual minus the amount of time traded by the patient, divided by the remaining life expectancy. Prior studies have demonstrated that the QALY associated with chronic bleeding is approximately 0.80.

Results

The main outcomes evaluated included overall costs per model arm, QALYs, the number of patients with cessation of bleeding, the frequency of endoscopic complications, and the overall mortality. The researchers estimated the probability of death over the course of the year based on age specific death rates from 2003 U.S. life tables in addition to the probability of death resulting from endoscopic procedural complications.

The study showed that the no-therapy arm was the least expensive but was also the least beneficial to the hypothetical patient (in other
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