Endoscopic Doppler Ultrasound Versus Endoscopic Stigmata-Directed Management of Acute Peptic Ulcer Hemorrhage: A Multimodel Cost Analysis

Dig Dis Sci. 2007 Jan;52(1):149-60. doi: 10.1007/s10620-006-9506-5. Epub 2006 Nov 16.

Abstract

Recurrent bleeding from acute peptic ulcer hemorrhage is problematic. Studies have shown that Doppler ultrasound (DOP-US) is useful in decreasing rebleeding. We analyzed associated costs and outcomes to better define the role of DOP-US versus Conventional (Forrest classification endoscopic stigmata) in the management of acute peptic ulcer bleeding. Two separate decision analyses were constructed. Recurrent bleeding, failed esophagogastroduodenoscopy (EGD) hemostasis, complications, and surgery rates were derived from medical literature. Costs were based on Medicare data. DOP-US is preferred over Conventional in acute peptic ulcer bleeding with average cost savings per patient ranging from 853 dollars (decision-tree modeling) to 1,160 dollars (Monte Carlo simulation). High-dose intravenous proton-pump inhibitors lowered rates of recurrent bleeding for both Conventional and DOP-US, resulting in a lower but still persistent average cost savings per patient for DOP-US (decision-tree modeling = 328 dollars, Monte Carlo simulation = 560 dollars). This decision analyses identified DOP-US as the preferred cost-minimizing strategy in acute peptic ulcer hemorrhage. Results of cost analyses were most dependent on hospitalization costs and recurrent bleeding rates.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Cost of Illness
  • Decision Trees*
  • Endoscopy, Gastrointestinal / economics*
  • Endosonography / economics*
  • Health Care Costs / statistics & numerical data*
  • Hospitalization / economics
  • Humans
  • Markov Chains
  • Medicare / economics
  • Models, Econometric
  • Monte Carlo Method
  • Peptic Ulcer Hemorrhage / diagnostic imaging
  • Peptic Ulcer Hemorrhage / drug therapy
  • Peptic Ulcer Hemorrhage / economics*
  • Peptic Ulcer Hemorrhage / therapy*
  • Proton Pump Inhibitors
  • Ultrasonography, Doppler / economics*
  • United States

Substances

  • Proton Pump Inhibitors