Matches in SemOpenAlex for { <https://semopenalex.org/work/W1964578965> ?p ?o ?g. }
- W1964578965 endingPage "936" @default.
- W1964578965 startingPage "920" @default.
- W1964578965 abstract "Background and Aims Of patients who are seen with GI hemorrhage, approximately 5% will have a small-bowel source. Management of these patients entails considerable expense. We performed a decision analysis to explore the optimal management strategy for obscure GI hemorrhage. Methods We used a cost-effectiveness analysis to compare no therapy (reference arm) to 5 competing modalities for a 50-year-old patient with obscure overt bleeding: (1) push enteroscopy, (2) intraoperative enteroscopy, (3) angiography, (4) initial anterograde double-balloon enteroscopy (DBE) followed by retrograde DBE if the patient had ongoing bleeding, and (5) small-bowel capsule endoscopy (CE) followed by DBE guided by the CE findings. The model included prevalence rates for small-bowel lesions, sensitivity for each intervention, and the probability of spontaneous bleeding cessation. We examined total costs and quality-adjusted life years (QALY) over a 1-year time period. Results An initial DBE was the most cost-effective approach. The no-therapy arm cost $532 and was associated with 0.870 QALYs compared with $2407 and 0.956 QALYs for the DBE approach, which resulted in an incremental cost-effectiveness ratio of $20,833 per QALY gained. Compared to the DBE approach, an initial CE was more costly and less effective. The initial DBE arm resulted in an 86% bleeding cessation rate compared to 76% for the CE arm and 59% for the no-therapy arm. The model results were robust to a wide range of sensitivity analyses. Limitations The short time horizon of the model, because of the lack of long-term data about the natural history of rebleeding from small-intestinal lesions. Conclusions An initial DBE is a cost-effective approach for patients with obscure bleeding. However, capsule-directed DBE may be associated with better long-term outcomes because of the potential for fewer complications and decreased utilization of endoscopic resources. Of patients who are seen with GI hemorrhage, approximately 5% will have a small-bowel source. Management of these patients entails considerable expense. We performed a decision analysis to explore the optimal management strategy for obscure GI hemorrhage. We used a cost-effectiveness analysis to compare no therapy (reference arm) to 5 competing modalities for a 50-year-old patient with obscure overt bleeding: (1) push enteroscopy, (2) intraoperative enteroscopy, (3) angiography, (4) initial anterograde double-balloon enteroscopy (DBE) followed by retrograde DBE if the patient had ongoing bleeding, and (5) small-bowel capsule endoscopy (CE) followed by DBE guided by the CE findings. The model included prevalence rates for small-bowel lesions, sensitivity for each intervention, and the probability of spontaneous bleeding cessation. We examined total costs and quality-adjusted life years (QALY) over a 1-year time period. An initial DBE was the most cost-effective approach. The no-therapy arm cost $532 and was associated with 0.870 QALYs compared with $2407 and 0.956 QALYs for the DBE approach, which resulted in an incremental cost-effectiveness ratio of $20,833 per QALY gained. Compared to the DBE approach, an initial CE was more costly and less effective. The initial DBE arm resulted in an 86% bleeding cessation rate compared to 76% for the CE arm and 59% for the no-therapy arm. The model results were robust to a wide range of sensitivity analyses. The short time horizon of the model, because of the lack of long-term data about the natural history of rebleeding from small-intestinal lesions. An initial DBE is a cost-effective approach for patients with obscure bleeding. However, capsule-directed DBE may be associated with better long-term outcomes because of the potential for fewer complications and decreased utilization of endoscopic resources." @default.
- W1964578965 created "2016-06-24" @default.
- W1964578965 creator A5052106176 @default.
- W1964578965 creator A5067786500 @default.
- W1964578965 date "2008-11-01" @default.
- W1964578965 modified "2023-10-05" @default.
- W1964578965 title "Cost-effectiveness analysis of management strategies for obscure GI bleeding" @default.
- W1964578965 cites W124202165 @default.
- W1964578965 cites W1429305406 @default.
- W1964578965 cites W1481334708 @default.
- W1964578965 cites W154779082 @default.
- W1964578965 cites W1967037876 @default.
- W1964578965 cites W1969447401 @default.
- W1964578965 cites W1972314788 @default.
- W1964578965 cites W1975888462 @default.
- W1964578965 cites W1978966819 @default.
- W1964578965 cites W1980686529 @default.
- W1964578965 cites W1985561231 @default.
- W1964578965 cites W1985674114 @default.
- W1964578965 cites W1987683206 @default.
- W1964578965 cites W1987747463 @default.
- W1964578965 cites W1988191179 @default.
- W1964578965 cites W1989569532 @default.
- W1964578965 cites W1991187211 @default.
- W1964578965 cites W1992617494 @default.
- W1964578965 cites W1994461011 @default.
- W1964578965 cites W1994478058 @default.
- W1964578965 cites W1995081753 @default.
- W1964578965 cites W1998047581 @default.
- W1964578965 cites W1999645808 @default.
- W1964578965 cites W2000182266 @default.
- W1964578965 cites W2003142227 @default.
- W1964578965 cites W2004405724 @default.
- W1964578965 cites W2004787773 @default.
- W1964578965 cites W2007631012 @default.
- W1964578965 cites W2008021347 @default.
- W1964578965 cites W2008717261 @default.
- W1964578965 cites W2009328573 @default.
- W1964578965 cites W2014001938 @default.
- W1964578965 cites W2017696389 @default.
- W1964578965 cites W2017840561 @default.
- W1964578965 cites W2019089972 @default.
- W1964578965 cites W2021092950 @default.
- W1964578965 cites W2022541880 @default.
- W1964578965 cites W2023207292 @default.
- W1964578965 cites W2027594372 @default.
- W1964578965 cites W2027910381 @default.
- W1964578965 cites W2028605375 @default.
- W1964578965 cites W2029413722 @default.
- W1964578965 cites W2032793989 @default.
- W1964578965 cites W2033293942 @default.
- W1964578965 cites W2035235924 @default.
- W1964578965 cites W2035585834 @default.
- W1964578965 cites W2036737805 @default.
- W1964578965 cites W2037565748 @default.
- W1964578965 cites W2037619025 @default.
- W1964578965 cites W2037705124 @default.
- W1964578965 cites W2041289436 @default.
- W1964578965 cites W2043180629 @default.
- W1964578965 cites W2044288440 @default.
- W1964578965 cites W2045966950 @default.
- W1964578965 cites W2046263349 @default.
- W1964578965 cites W2052154117 @default.
- W1964578965 cites W2052579250 @default.
- W1964578965 cites W2052737372 @default.
- W1964578965 cites W2054310410 @default.
- W1964578965 cites W2055569105 @default.
- W1964578965 cites W2057440046 @default.
- W1964578965 cites W2057565866 @default.
- W1964578965 cites W2058139095 @default.
- W1964578965 cites W2059218639 @default.
- W1964578965 cites W2059429210 @default.
- W1964578965 cites W2060505523 @default.
- W1964578965 cites W2061463961 @default.
- W1964578965 cites W206452320 @default.
- W1964578965 cites W2065687429 @default.
- W1964578965 cites W2066891536 @default.
- W1964578965 cites W2067656788 @default.
- W1964578965 cites W2067940826 @default.
- W1964578965 cites W2068046050 @default.
- W1964578965 cites W2072571958 @default.
- W1964578965 cites W2074498630 @default.
- W1964578965 cites W2082223635 @default.
- W1964578965 cites W2082413033 @default.
- W1964578965 cites W2082716163 @default.
- W1964578965 cites W2083189921 @default.
- W1964578965 cites W2086138096 @default.
- W1964578965 cites W2086404982 @default.
- W1964578965 cites W2089371593 @default.
- W1964578965 cites W2094652048 @default.
- W1964578965 cites W2107694023 @default.
- W1964578965 cites W2123293411 @default.
- W1964578965 cites W2124220836 @default.
- W1964578965 cites W2138596069 @default.
- W1964578965 cites W2140575394 @default.
- W1964578965 cites W2140696324 @default.
- W1964578965 cites W2148127765 @default.
- W1964578965 cites W2149454449 @default.