The cost of knowing the truth-limitations to a cost-benefit analysis of upper GI endoscopy

In a prospective series of 284 upper gastrointestinal (GI) endoscopies, outcome was evaluated by a cost-benefit analysis. Two-thirds of the endoscopies had a negative result, or a diagnosis was found which was not worth the costs of the endoscopy. The overall diagnostic gain of 284 endoscopies, however, outweighed the costs by a factor of three. Since at least one-third of the decision to endoscope are made for reasons other than seeking specific diagnosis, the applicability of a cost-benefit analysis to upper GI endoscopy is limited.