Endoscopic Doppler Ultrasound Versus Endoscopic Stigmata-Directed Management of Acute Peptic Ulcer Hemorrhage: A Multimodel Cost Analysis

Abstract

Recurrent bleeding from acute peptic ulcer hemorrhage is problematic. Studies have shown that Doppler ultrasound (DOP-US) is useful in decreasing rebleeding. We analyzed associated costs and outcomes to better define the role of DOP-US versus Conventional (Forrest classification endoscopic stigmata) in the management of acute peptic ulcer bleeding. Two separate decision analyses were constructed. Recurrent bleeding, failed esophagogastroduodenoscopy (EGD) hemostasis, complications, and surgery rates were derived from medical literature. Costs were based on Medicare data. DOP-US is preferred over Conventional in acute peptic ulcer bleeding with average cost savings per patient ranging from 853 dollars (decision-tree modeling) to 1,160 dollars (Monte Carlo simulation). High-dose intravenous proton-pump inhibitors lowered rates of recurrent bleeding for both Conventional and DOP-US, resulting in a lower but still persistent average cost savings per patient for DOP-US (decision-tree modeling = 328 dollars, Monte Carlo simulation = 560 dollars). This decision analyses identified DOP-US as the preferred cost-minimizing strategy in acute peptic ulcer hemorrhage. Results of cost analyses were most dependent on hospitalization costs and recurrent bleeding rates.

Advancements in endoscopic hemostasis for non-variceal upper gastrointestinal bleeding

“…In patients whose treated lesions exhibited a positive EDP signal, the risk of rebleeding was higher than those with a negative EDP signal [OR 25.96 (95%CI: 6.74-100)][ 46 ]. In cost-analyses, EDP is cost-effective compared to conventional visually guided therapy in acute peptic ulcer bleeding[ 47 , 48 ].…”

Hemostasis Techniques for Non-variceal Upper GI Hemorrhage: Beyond Injection and Cautery

“…In a meta-analysis of 526 patients enrolled in ten studies, no patients experienced any DEP-related adverse events [ 21 ]. DEP has also been shown to be cost effective when compared to conventional, visually guided therapy in acute peptic ulcer bleeding (PUB) in several different cost-analyses [ 22 – 24 ]. As one example, when used to direct treatment of ulcers with flat pigmented spots (Forrest 2C), DEP-guided therapy was more effective and less expensive than visually guided hemoclips over a 30 day time horizon [ 23 ].…”

Reply

“…These improvements in patient care with use of the DEP will ultimately also reduce hospital and patient care costs of severe NVUGIB. 8 DENNIS M. JENSEN David Geffen School of Medicine at UCLA Los Angeles, California…”