Comment: Economic Analysis of obscure GI bleeding management
Source:    Publish Time: 2012-08-16 07:23   1364 Views   Size:  16px  14px  12px
Author: Xuanqian Xie. This comment has not been peer-reviewed. Article: Gerson L, Kamal A. Cost-effectiveness analy

Author: Xuanqian Xie. This comment has not been peer-reviewed.


Article: Gerson L, Kamal A. Cost-effectiveness analysis of management strategies for obscure GI bleeding. Gastrointest Endosc 2008; 68(5):920-936.


If I understand correctly, the capsule-directed DBE arm referred to capsule endoscopy (CE) followed by DBE for patients with continued bleeding. In the end of the result section, authors said “In the initial CE arm, all 1000 patients would undergo a CE; approximately 237 patients would require a DBE after the CE examination because of ongoing bleeding, and, subsequently, 47 patients would experience ongoing bleeding and require a DBE via the opposite approach.” If I understand correctly, 47 patients were still bleeding after both CE and DBE eventually. But, in the Table 5, authors presented 235 patients with ongoing bleeding, which was derived from the initial CE only, not both endoscopies. Possibly it was inappropriate, since authors stated that the model arm was “capsule-directed DBE”, but they reported results based on CE alone.

(If I understand correctly), authors’ calculation of QALY in capsule-directed DBE arm is also based on CE alone, rather than both endoscopies. Therefore, the effectiveness in the capsule-directed DBE arm was less than that in DBE alone arm.

The management of GI bleeding is very complicated. The order of various endoscopies has not yet been well established, although some guidelines suggested the patient pathway of tests. It would be nice to see more articles on the economic analysis on this field.  

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