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Second-look endoscopy for bleeding peptic ulcer disease: a decision-effectiveness and cost-effectiveness analysis
1Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA. timperia@iupui.edu
Journal of Clinical Gastroenterology
|February 3, 2012
Summary
Routine second-look endoscopy for bleeding peptic ulcers is not routinely advised. It may be cost-effective only if rebleeding risk exceeds 31%.
Area of Science:
- Gastroenterology
- Health Economics
Background:
- Second-look endoscopy (SLE) after initial therapeutic endoscopy for bleeding peptic ulcer disease (PUD) may reduce rebleeding.
- However, routine SLE is not currently recommended, necessitating an understanding of its clinical utility.
Purpose of the Study:
- To compare the clinical outcomes and costs of routine second-look endoscopy versus no second-look endoscopy for bleeding peptic ulcer disease.
Main Methods:
- A decision model was employed, incorporating literature-based probabilities and Medicare reimbursement costs.
- The study evaluated rebleeding rates, surgical necessity, hospital mortality, and associated costs.
- Cost-effectiveness was assessed by calculating the cost to avoid each outcome (number needed to treat) and cost per outcome prevented.
Main Results:
- Routine SLE reduced rebleeding from 16% to 10% (NNT=16) with a cost of nearly $13,000 per rebleeding case prevented.
- Cost neutrality between routine SLE and no SLE was achieved at a rebleeding threshold of 31%.
- If SLE was 100% effective, the cost-neutral rebleeding threshold decreased to 17.5%.
Conclusions:
- Routine second-look endoscopy is not indicated for bleeding peptic ulcer disease following initial therapeutic endoscopy.
- SLE may be considered if the initial rebleeding risk is 31% or higher, as it can reduce risk without additional cost.
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