PGI17 COST EFFECTIVENESS ANALYSIS OF ENDOSCOPIC CAPSULE FOR DIAGNOSIS OF OBSCURE GASTROINTESTINAL BLEEDING IN THE BRAZILIAN PRIVATE HEALTHCARE SYSTEM

Abstract

To evaluate the cost-effectiveness of endoscopic capsule (EC) as enteroscopic diagnostic technique, compared to diagnostic procedures currently included in Brazilian private healthcare system, specifically, push enteroscopy using a standard probe and a double-balloon enteroscopy A decision tree model was developed from private payer perspective. The study population was adult patients diagnosed with gastrointestinal bleeding of obscure origin. The primary clinical outcome was diagnostic yield of each comparator; complications were included as a secondary outcome. Clinical data was identified through a literature review and final outcomes were calculated using a meta-analysis. Direct medical costs were included, taken from 2018 private insurance pricing charts (CBHPM) and presented in 2019 BRL and USD. Time horizon adopted was disease diagnosis and complications/adverse events timeframe. There was no discount rate. An univariate sensitivity analysis was conducted. A cost-effectiveness ratio was calculated two scenarios: 1) EC vs push enteroscopy and 2) EC vs double ballon enteroscopy. In the first analysis, EC presents an incremental diagnostic yield of 0.14 and an incremental cost of BRL 1,099 (USD 274), resulting in an ICER of BRL 7,931 (USD 1,982). In comparison to double ballon enteroscopy, EC results in an incremental diagnostic yield of -0.04 and an incremental cost of BRL 2,451 (USD 612). As such, EC is a dominant therapy compared to double balloon enteroscopy. Sensitivity analysis indicated that the results were robust to variations in both cost and effectiveness variables. Cost of EC and push enteroscopy were the varibles with the greatest impact on results. The analysis indicates that enteroscopy with endoscopic capsule has lower costs and a better diagnostic yield when compared to double balloon enteroscopy, making it a dominant alternative. Compared to push enteroscopy, EC may be considered a cost-effectiveness therapy that considerably improves the diagnostic yield.