Lower Diagnostic Costs Associated With Early Deployment of Capsule Endoscopy in Non-hematemesis Gastrointestinal Bleeding: A Cost-utilization Analysis
Abstract Introduction: Often, the diagnostic workup of patients presenting with non-hematemesis gastrointestinal bleeding (NHGIB) is inconclusive. Consequently, the diagnostic evaluation may incur unnecessary health care costs and diagnostic times. The use of a cost decision-analytical model of the current diagnostic management strategy applied to patients presenting with NHGIB may reveal alternative strategies for the evaluation of NHGIB.Methods: Cost decision-analytical model that retrospectively follows the diagnostic course of 231 consecutive patients presenting with NHGIB to the emergency department (ED) of a tertiary medical center. We measured the effect (cost and relative times) of selecting a specific procedure, plus the effect of pursuing secondary procedures after non-diagnostic primary procedures.Results: A primary VCE had a diagnostic rate of 68% vs. 45% and 48% for a primary EGD and COLO, respectively. Combining the diagnostic rates for each primary procedure with the cost of performing subsequent procedures (after non-diagnostic primary procedures), demonstrates the primary use of VCE (n=9) results in a total cost of $12,146 vs. $12,746 and $13,162 for a primary EGD (n=47) and COLO (n=33), respectively. Similarly, the use of VCE as a primary diagnostic procedure in NHGIB patients admitted to the floor would take 74 unit hours to reach a diagnosis compared to 104 and 131 for EGD and COLO, respectively.Conclusion: Our model suggests initial use of VCE for the diagnosis of acute NHGIB, may reduce time to diagnosis and management costs.