Cost-effective means of diagnosing and following benign and malignant gastric ulcers

To define the most cost-effective means of diagnosing and following gastric ulcers, both benign and malignant, the University of Utah Medical Center (UUMC) experience between September 1980 and October 1983 was reviewed. Endoscopy (EGD) was utilized in the initial evaluation process in 96% of patients. Follow-up was performed by either a combination of EGD and double contrast upper GI (DCUGI) or EGD alone. Diagnostic and follow-up modality had no effect on survival. It appears that the high-frequency use of EGD for gastric ulcer management is not cost-effective. We suggest an algorithm in which EGD would be used only following failure either to demonstrate characteristic benign appearance on DCUGI or inadequate healing following therapeutic trial. A theoretical net savings of 55% is calculated by retrospective application of the algorithm to the UUMC experience; 30% savings is realized for diagnosis and 81% for follow-up. If adopted on a national scale, the algorithm proposed may result in a significant savings in health-care cost.