Cost-effective diagnosis of ingested foreign bodies

Area of Science:

• Medical Imaging
• Health Economics
• Gastroenterology

Background:

• Retained ingested foreign bodies present a diagnostic challenge.
• Choosing the optimal initial imaging modality impacts patient outcomes and healthcare costs.

Purpose of the Study:

• To compare the cost-effectiveness of plain film radiography, computed tomography (CT), and endoscopy for diagnosing ingested foreign bodies.
• To identify the most efficient diagnostic strategy for adult patients.

Main Methods:

• A systematic literature review identified 16 studies with 7,088 patients.
• Cost-effectiveness analysis utilized 2006 Medicare reimbursement data.
• Decision tree modeling and sensitivity analyses were performed.

Main Results:

• Computed tomography (CT) scanning was the most cost-effective initial diagnostic strategy.
• Immediate endoscopy yielded an incremental cost of $5,238 per additional correctly diagnosed patient.
• Plain radiography was less effective and more costly than CT or endoscopy.

Conclusions:

• CT scan is the preferred initial diagnostic modality for retained ingested foreign bodies after history and physical.
• Endoscopy can be considered if CT is unavailable, but at a higher cost.
• Plain films are inferior to CT and endoscopy for this indication.