"outcomes research" のすすめ

Abstract

Results: Tornado analysis revealed that the model is highly sensitive to the cost of FS, and that if this cost was below $388, FS was the superior strategy. In a hypothetical cohort of patients, we determined that FS, followed by EGD if colonic biopsies were negative resulted in the lowest cost for diagnosis of $206. Th is was a superior strategy to EGD and FS on the same day as it resulted in lower costs and reasonable utilities considering a wait of 2 or 3 days from FS to interpretation of biopsies by a pathologist. Other strategies resulted in superior diagnostic yields, but at costs exceeding a willingness-to-pay threshold of $50,000/QALY. Th ese results were robust for both cohorts of patients with nausea and vomiting and those without. Conclusion: Strictly from a cost-eff ectiveness standpoint, fl exible sigmoidoscopy with biopsy followed by EGD with small bowel biopsy in patients with negative results from the fl exible sigmoidoscopy appears to be the superior strategy. However, from a practical standpoint, EGD and fl exible sigmoidoscopy with biopsies results in shorter time to diagnosis for the cohort and results in modest improvement of utilities for the group as a whole. In both groups, a strategy of colonoscopy without ileal intubation and biopsies.