Ad hoc cost analysis of the new gastrointestinal bleeding algorithm in patients with ventricular assist device

Area of Science:

• Cardiovascular Surgery
• Gastroenterology
• Medical Device Technology

Background:

• Gastrointestinal bleeding (GIB) is a frequent complication in patients with nonpulsatile ventricular assist devices (VAD).
• Previous research highlighted the need for improved diagnostic and management strategies for GIB in this patient population.

Purpose of the Study:

• To evaluate a novel algorithm utilizing deep bowel enteroscopy for the workup of GIB in VAD patients.
• To compare the efficacy, resource utilization, and cost-effectiveness of the new algorithm against traditional GIB workup protocols.

Main Methods:

• Implementation of a new diagnostic algorithm centered on deep bowel enteroscopy for GIB in VAD patients.
• Comparison of patient outcomes, including procedure frequency, transfusion requirements, and diagnostic time, between the new algorithm group and a historical control group undergoing traditional GIB workup.

Main Results:

• The new algorithm group experienced fewer diagnostic procedures and required fewer transfusions compared to the traditional group.
• Diagnosis of GIB was achieved more rapidly with the new algorithm.
• Significant cost savings were observed, with procedure charges averaging ~$2,902 per episode in the new algorithm group versus ~$9,013 in the traditional group (p < 0.0001).

Conclusions:

• The novel deep bowel enteroscopy algorithm offers a more efficient and cost-effective approach to managing GIB in VAD patients.
• This strategy leads to reduced healthcare resource utilization, including fewer transfusions and diagnostic tests, while achieving substantial cost savings per bleeding episode.