Document Detail


Evaluation and therapy of the patient with fecal occult blood loss: a decision analysis.
MedLine Citation:
PMID:  2117850     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We performed a decision analysis to evaluate cost per cancer detected, cost per neoplasm detected, and cost per treatable lesion of two common diagnostic strategies, barium enema-proctoscopy or colonoscopy as the first diagnostic test, for patients with fecal occult blood loss. The prevalence of polyps, cancer, and angiodysplasia, and the colonoscopy success rate were obtained from consecutive colonoscopy records. Costs were estimated from hospital charges; sensitivity and specificity of barium enema and colonoscopy were obtained from the literature. For treatable lesions (cancer, polyps, and angiodysplasia), the colonoscopy first strategy had a higher sensitivity (80% vs. 57%) and a higher specificity (95% vs. 80%) than the barium enema first strategy. Cost effectiveness measures were similar for the two strategies. Colonoscopy as the first diagnostic test had a lower cost per treatable lesion ($2,319 vs. $2,895) and a lower cost per neoplasm detected ($2,694 vs. $2,896), whereas the barium enema first strategy had a lower cost per cancer detected ($10,050 vs. $10,297). The lower cost per treatable lesion of the colonoscopy first strategy was not affected by changes in the prevalence of lesions, test characteristics, costs of tests, or colonoscopy success rate over clinically relevant ranges. The higher cost of colonoscopy was offset by its greater sensitivity and its capacity for biopsy and therapy. Therefore, since the cost per treatable lesion is lower and the sensitivity, specificity, and predictive value is superior, colonoscopy is recommended as the preferred initial test in evaluating a patient with fecal occult blood loss.
Authors:
B A Lashner; M D Silverstein
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  85     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  1990 Sep 
Date Detail:
Created Date:  1990-09-27     Completed Date:  1990-09-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1088-95     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Chicago Medical Center.
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MeSH Terms
Descriptor/Qualifier:
Barium Sulfate / diagnostic use
Colonoscopy / economics*
Colorectal Neoplasms / diagnosis,  epidemiology
Cost-Benefit Analysis
Decision Support Techniques*
Decision Trees
Diagnosis, Differential
Enema / economics*
Humans
Intestinal Polyps / diagnosis,  epidemiology
Occult Blood*
Predictive Value of Tests
Prevalence
Proctoscopy / economics*
Sensitivity and Specificity
Chemical
Reg. No./Substance:
7727-43-7/Barium Sulfate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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