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 22 February 2018

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News

Endoscopic ultrasonography for upper gastrointestinal submucosal lesions

When used to diagnose submucosal lesions, endoscopic ultrasonography may reduce the need for further tests, but not necessarily costs, find investigators in the September issue of the American Journal of Gastroenterology.

News image

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A previous study compared the management of submucosal tumors (SMTs), with and without endoscopic ultrasound (EUS). This showed that EUS reduced the need for further tests, but it was unclear whether costs were also reduced.

In this study, the same team of international investigators determined whether EUS would reduce costs.

The team based this study on the data from their previous clinical study. They compared direct hospital costs for diagnosing SMTs, with and without EUS.

They used cost data from Germany, Canada, Japan, France, and the United States, and expressed all costs as a ratio of the cost of esophagogastroduodenoscopy (EGD).

Costs for each procedure were;

  • EGD = 1
  • large particle biopsy (LPB) = 0.75
  • endoscopic ultrasound (EUS) = 2.0
  • abdominal ultrasound (US) = 0.77
  • computed tomography (CT) = 1.79
  • magnetic resonance imaging (MRI) = 3.54
  • ERCP = 3.45.

The team found that initial calculations showed that the "no EUS" strategy was less costly on average. It was also less costly for all countries individually, excepting Germany.

They determined that overall management costs were sensitive to the relative costs of CT and EUS, the cost of LPB, and to the probability of no further testing in the "no EUS" strategy.

The "no EUS" strategy was less costly on average.
American Journal of Gastroenterology

However, threshold analysis found that "EUS" became less costly if the cost of EUS was less than 85% of the cost of CT.

In addition, if the potential for EUS to reduce severe complications caused by LPB of high risk lesions was greater than 2% then "EUS" becomes less costly.

Dr Anand Sahai's team concluded, "When used to diagnose SMTs, EUS may reduce the need for further tests but not necessarily costs".

"For this indication, the relative cost of EUS compared with CT is what most limits its potential value as a cost-minimizing test".

"The costs, economic impact, and hence the relative appropriateness of EUS and other procedures may vary in different health care systems".

Am J Gastroenterol 2003; 98(9): 1989-95
23 September 2003

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