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Initial evaluation of rectal bleeding in young persons: a cost-effectiveness analysis.

James D Lewis1, Alphonso Brown, A Russell Localio

  • 1Center for Clinical Epidemiology and Biostatistics, Blockley Hall, 9th Floor, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA.

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Summary

Evaluating young patients with rectal bleeding using flexible sigmoidoscopy offers a cost-effective approach, significantly increasing life expectancy. This strategy proves more beneficial than no evaluation or anoscopy alone for individuals aged 25-45.

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Area of Science:

  • Gastroenterology
  • Health Economics
  • Diagnostic Strategy Evaluation

Background:

  • Rectal bleeding in young patients presents a frequent diagnostic challenge.
  • Determining the most effective and economical diagnostic methods is crucial for this demographic.

Purpose of the Study:

  • To assess the relative cost-effectiveness of various diagnostic strategies for young adults experiencing rectal bleeding.
  • To identify optimal diagnostic pathways that maximize life expectancy and minimize costs.

Main Methods:

  • A cost-effectiveness analysis was conducted using a Markov model.
  • Data on probabilities were sourced from medical literature, with costs based on Medicare reimbursement rates and literature.
  • The study population included individuals aged 25 to 45 with asymptomatic rectal bleeding, with a lifetime time horizon.

Main Results:

  • For 35-year-old patients, flexible sigmoidoscopy was highly cost-effective compared to no evaluation or anoscopy-based strategies, with an incremental cost below $5300 per year of life gained.
  • A combination of flexible sigmoidoscopy and barium enema offered the greatest life expectancy but at a higher incremental cost ($23,918 per life-year gained) compared to flexible sigmoidoscopy alone.
  • Sensitivity analyses indicated that the cost-effectiveness of strategies like flexible sigmoidoscopy plus barium enema versus colonoscopy was influenced by test sensitivity.

Conclusions:

  • Diagnostic evaluation of the colon in young adults (25-45) with rectal bleeding improves life expectancy.
  • The cost of these evaluations is comparable to established colon cancer screening programs.
  • Flexible sigmoidoscopy emerges as a particularly cost-effective initial strategy for this patient group.