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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.


Cost outcome. A: Influential parameters on the incremental cost; B: Two-way sensitivity analysis depicting the less costly strategy, in regards to serological tests and small bowel biopsies prices.
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Figure 2: Cost outcome. A: Influential parameters on the incremental cost; B: Two-way sensitivity analysis depicting the less costly strategy, in regards to serological tests and small bowel biopsies prices.

Mentions: The average cost of strategy A was $218.10 vs $234.17 for strategy B. These results are explained by the lower cost of performing serological tests only in patients with positive CD biopsies compared to performing them in the whole study population. As shown in Figure 2A, the costs of serological tests, biopsies and patients’ symptoms evaluation had the greatest impact on the incremental average cost.


Cost effectiveness of routine duodenal biopsies in iron deficiency anemia
Cost outcome. A: Influential parameters on the incremental cost; B: Two-way sensitivity analysis depicting the less costly strategy, in regards to serological tests and small bowel biopsies prices.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Cost outcome. A: Influential parameters on the incremental cost; B: Two-way sensitivity analysis depicting the less costly strategy, in regards to serological tests and small bowel biopsies prices.
Mentions: The average cost of strategy A was $218.10 vs $234.17 for strategy B. These results are explained by the lower cost of performing serological tests only in patients with positive CD biopsies compared to performing them in the whole study population. As shown in Figure 2A, the costs of serological tests, biopsies and patients’ symptoms evaluation had the greatest impact on the incremental average cost.

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.