Limits...
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

Incremental cost-effectiveness ratio outcome. A: Parameters that affected the incremental cost-effectiveness ratio (ICER) analysis; B: ICER of both strategies in regard to the cost of small bowel biopsies. CD: Celiac disease; GFD: Gluten free diet.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5016382&req=5

Figure 3: Incremental cost-effectiveness ratio outcome. A: Parameters that affected the incremental cost-effectiveness ratio (ICER) analysis; B: ICER of both strategies in regard to the cost of small bowel biopsies. CD: Celiac disease; GFD: Gluten free diet.

Mentions: Analyzing the ICER for both strategies, we found that strategy A was more cost effective than strategy B. Figure 3A demonstrates the parameters that affected the ICER analysis. As shown in Figure 3B, for a cost of biopsy less than $77, the universal SBBs strategy dominated (i.e., costs less with higher QALY). However, when the cost of biopsy was greater than $77, the ICER increased up to almost $3000 per QALY and the strategy of conducting SBBs only in patients with positive serology dominated.


Cost effectiveness of routine duodenal biopsies in iron deficiency anemia
Incremental cost-effectiveness ratio outcome. A: Parameters that affected the incremental cost-effectiveness ratio (ICER) analysis; B: ICER of both strategies in regard to the cost of small bowel biopsies. CD: Celiac disease; GFD: Gluten free diet.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Incremental cost-effectiveness ratio outcome. A: Parameters that affected the incremental cost-effectiveness ratio (ICER) analysis; B: ICER of both strategies in regard to the cost of small bowel biopsies. CD: Celiac disease; GFD: Gluten free diet.
Mentions: Analyzing the ICER for both strategies, we found that strategy A was more cost effective than strategy B. Figure 3A demonstrates the parameters that affected the ICER analysis. As shown in Figure 3B, for a cost of biopsy less than $77, the universal SBBs strategy dominated (i.e., costs less with higher QALY). However, when the cost of biopsy was greater than $77, the ICER increased up to almost $3000 per QALY and the strategy of conducting SBBs only in patients with positive serology dominated.

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