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Study identifies double-balloon enteroscopy as cost-effective approach for obscure GI bleeding
Date:11/24/2008

words, associated with the lowest number of quality-adjusted life-years). The arm that had a DBE performed as the initial procedure was more expensive, but was associated with the greatest number of quality-adjusted life-years and the greatest number of patients with cessation of bleeding. All of the other strategies were less effective than the DBE arm and more expensive (with exception of push enteroscopy and the no-therapy arm, which were both less expensive). The no-therapy arm cost $532 and was associated with 0.870 QALYs, whereas the DBE arm cost $2,407 and was associated with 0.956 QALYs, which resulted in an incremental cost-effectiveness ratio of $20,833 per QALY gained. Cost-effectiveness ratios that are less than $50,000 per QALY are considered to be associated with favorable strategies and a reasonable health investment; other examples include $10,000 - $25,000 per QALY for colon or breast cancer screening (figures according to the American Health Quality Association).

Compared with a DBE, an initial CE was more costly and less effective. Based on these results, approximately 86.5 percent of patients would experience cessation of hemorrhage over the course of a year in the DBE arm compared with 76 percent in the CE arm and 59 percent in the no-therapy arm.

The authors concluded that double-balloon enteroscopy, compared to other imaging modalities for obscure GI bleeding, is a cost-effective approach based on the capability of administering therapy during the examination and avoiding the additional cost of the capsule examination. The limitation of these conclusions, however, is the current lack of availability of DBE in many centers. In addition, the rate of complications associated with DBE is currently higher (approximately one percent) compared to standard endoscopic procedures. The study notes that because an initial capsule endoscopy reduced the number of DBE procedures and had fewer associated complications, capsule-directed DBE
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Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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