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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.


Validation. A: Monte Carlo simulation of 100 sample trials with 10000 patients in each trial; B: Acceptability curve that validate the cost effectiveness results of the study in relation to the willingness to pay for each quality adjusted life year (QALY). SBB: Small bowel biopsie.
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Figure 4: Validation. A: Monte Carlo simulation of 100 sample trials with 10000 patients in each trial; B: Acceptability curve that validate the cost effectiveness results of the study in relation to the willingness to pay for each quality adjusted life year (QALY). SBB: Small bowel biopsie.

Mentions: The results of the Monte Carlo simulation (Figure 4A) of 100 sampling trials with 10000 patients in each trial, demonstrate that strategy A yielded the same QALY with lower costs than strategy B. Finally, in order to verify our results, we performed an acceptability curve (Figure 4B). This figure demonstrates that as the willingness to pay for each QALY increases, the validity of our cost effectiveness study increases as well. For example, if the willingness to pay for 1 QALY is $10000 the probability of the validity of our results would be approximately 98%.


Cost effectiveness of routine duodenal biopsies in iron deficiency anemia
Validation. A: Monte Carlo simulation of 100 sample trials with 10000 patients in each trial; B: Acceptability curve that validate the cost effectiveness results of the study in relation to the willingness to pay for each quality adjusted life year (QALY). SBB: Small bowel biopsie.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Validation. A: Monte Carlo simulation of 100 sample trials with 10000 patients in each trial; B: Acceptability curve that validate the cost effectiveness results of the study in relation to the willingness to pay for each quality adjusted life year (QALY). SBB: Small bowel biopsie.
Mentions: The results of the Monte Carlo simulation (Figure 4A) of 100 sampling trials with 10000 patients in each trial, demonstrate that strategy A yielded the same QALY with lower costs than strategy B. Finally, in order to verify our results, we performed an acceptability curve (Figure 4B). This figure demonstrates that as the willingness to pay for each QALY increases, the validity of our cost effectiveness study increases as well. For example, if the willingness to pay for 1 QALY is $10000 the probability of the validity of our results would be approximately 98%.

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.