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Cost-effectiveness of Endoscopy in Irritable Bowel Syndrome
Saud Suleiman, MD;
Amnon Sonnenberg, MD, MSc
Arch Intern Med. 2001;161:369-375.
Background It is unknown to what extent at what expense flexible sigmoidoscopy
and colonoscopy add to the diagnosis of irritable bowel syndrome (IBS). The
aim of the study was to assess the incremental cost-effectiveness of endoscopic
procedures in the workup for IBS.
Methods Using the Bayes formula, we calculated the increase in diagnostic certainty
for a consecutive number of tests. We also calculated the incremental cost-effectiveness
ratio, which corresponds to the test costs divided by the increment in diagnostic
certainty.
Results The diagnosis of IBS can be established with a relatively high probability
of more than 80% relying on relatively inexpensive and noninvasive tests only.
Flexible sigmoidoscopy or colonoscopy constitute the most costly portion of
any workup for IBS, which amounts to 50% to 75% of the overall costs. Because
of their high incremental cost-effectiveness ratio, endoscopic procedures
should not be used at the beginning of the diagnostic workup. This outcome
of the analysis remains largely unaffected within reasonable ranges of the
sensitivity and specificity of various tests.
Conclusions In the diagnosis of IBS, inexpensive, noninvasive tests should be used
first to rule out other diagnoses. Despite their high incremental cost-effectiveness
ratio, flexible sigmoidoscopy and colonoscopy are indicated when a serious
organic disease is reasonably likely and needs to be ruled out.
From the Department of Veterans Affairs Medical Center and University
of New Mexico, Albuquerque, NM.
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Arch Intern Med. 2001;161(3):487-488.
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