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Cost effectiveness of routine duodenal biopsies in iron deficiency anemia

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To investigate the cost effectiveness of routine small bowel biopsies (SBBs) in patients with iron deficiency anemia (IDA) independent of their celiac disease (CD) serology test results.

Methods: We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy (EGD) in all patients with IDA regardless their celiac serology status (strategy A) vs SBBs only in IDA patients with positive serology (strategy B). The main outcomes were quality adjusted life years (QALY), average cost and the incremental cost effectiveness ratio (ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results, a Monte Carlo simulation of 100 sample trials with 10, and an acceptability curve were performed.

Results: Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness, strategy A was the dominant strategy, as long as the cost of SBBs stayed less than $67. In addition, the ICER of strategy A was preferable, providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B.

Conclusion: Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA, regardless of their celiac antibody status.

No MeSH data available.


Related in: MedlinePlus

Quality adjusted life-years outcome. A: Influential parameters on the incremental quality adjusted life-years (QALY); B: One-way sensitivity analysis figure of the prevalence of celiac disease; C: One-way sensitivity analysis figure of the utility of celiac disease; D: One-way sensitivity analysis figure of the probability of diagnosing celiac disease due to symptoms. CD: Celiac disease; GFD: Gluten free diet; SBB: Small bowel biopsy.
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Figure 1: Quality adjusted life-years outcome. A: Influential parameters on the incremental quality adjusted life-years (QALY); B: One-way sensitivity analysis figure of the prevalence of celiac disease; C: One-way sensitivity analysis figure of the utility of celiac disease; D: One-way sensitivity analysis figure of the probability of diagnosing celiac disease due to symptoms. CD: Celiac disease; GFD: Gluten free diet; SBB: Small bowel biopsy.

Mentions: The strategy to obtain SBBs regardless the serological results (strategy A) yielded 19.888 QALY, and dominated the strategy of conducting SBBs only in patients with a positive serological test (strategy B), which had 19.887 QALY. Figure 1A is a Tornado plot showing the different parameters that had an impact on the incremental QALY. The most influential parameters on the QALY outcome were the prevalence of CD in IDA patients, the utility of CD and the probability of identifying CD due to symptoms. As demonstrated in the one-way sensitivity analysis figures of these parameters (Figure 1B-D, respectively), the dominance of the strategy of performing SBBs in all IDA patients was robust.


Cost effectiveness of routine duodenal biopsies in iron deficiency anemia
Quality adjusted life-years outcome. A: Influential parameters on the incremental quality adjusted life-years (QALY); B: One-way sensitivity analysis figure of the prevalence of celiac disease; C: One-way sensitivity analysis figure of the utility of celiac disease; D: One-way sensitivity analysis figure of the probability of diagnosing celiac disease due to symptoms. CD: Celiac disease; GFD: Gluten free diet; SBB: Small bowel biopsy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016382&req=5

Figure 1: Quality adjusted life-years outcome. A: Influential parameters on the incremental quality adjusted life-years (QALY); B: One-way sensitivity analysis figure of the prevalence of celiac disease; C: One-way sensitivity analysis figure of the utility of celiac disease; D: One-way sensitivity analysis figure of the probability of diagnosing celiac disease due to symptoms. CD: Celiac disease; GFD: Gluten free diet; SBB: Small bowel biopsy.
Mentions: The strategy to obtain SBBs regardless the serological results (strategy A) yielded 19.888 QALY, and dominated the strategy of conducting SBBs only in patients with a positive serological test (strategy B), which had 19.887 QALY. Figure 1A is a Tornado plot showing the different parameters that had an impact on the incremental QALY. The most influential parameters on the QALY outcome were the prevalence of CD in IDA patients, the utility of CD and the probability of identifying CD due to symptoms. As demonstrated in the one-way sensitivity analysis figures of these parameters (Figure 1B-D, respectively), the dominance of the strategy of performing SBBs in all IDA patients was robust.

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To investigate the cost effectiveness of routine small bowel biopsies (SBBs) in patients with iron deficiency anemia (IDA) independent of their celiac disease (CD) serology test results.

Methods: We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy (EGD) in all patients with IDA regardless their celiac serology status (strategy A) vs SBBs only in IDA patients with positive serology (strategy B). The main outcomes were quality adjusted life years (QALY), average cost and the incremental cost effectiveness ratio (ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results, a Monte Carlo simulation of 100 sample trials with 10, and an acceptability curve were performed.

Results: Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness, strategy A was the dominant strategy, as long as the cost of SBBs stayed less than $67. In addition, the ICER of strategy A was preferable, providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B.

Conclusion: Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA, regardless of their celiac antibody status.

No MeSH data available.


Related in: MedlinePlus