Economic and health outcomes of capsule endoscopy: Opportunities for improved management of the diagnostic process for obscure gastrointestinal bleeding

The estimated annual incidence of gastrointestinal bleeding in the United States is approximately 100 episodes per 100,000 persons, resulting in 300,000 hospitalizations annually. Diagnostic tools such as radiologic studies and endoscopic examination often fail to identify a source of bleeding, resulting in a cycle of repetitive testing over months or even years. Costs associated with the diagnostic process, and with interim treatment for anemia and other symptoms, can be significant. The diagnostic process also takes a toll on the patient, in terms of worry, pain, and discomfort. Capsule endoscopy, a technology that received FDA clearance in August, 2001, consists of a video capsule that is ingested by the patient, and that transmits images to a wireless data recorder worn on the belt. The recorded stream of approximately 50,000 images can be reviewed on a computer workstation by a physician to identify nature and location of potential sources of bleeding. This paper presents a framework for economic analysis of this new technology. First, we present a review of the literature on the current diagnostic methods. Next, we present a conceptual model for examining contributors to costs in diagnosing obscure intestinal bleeds. We conclude by exploring the potential economic impact of the technology. Analysis of data from the first U.S. clinical trial of capsule endoscopy demonstrates its high diagnostic yield, and patient satisfaction. While further study is required, this analysis indicates that capsule endoscopy may reduce total medical utilization and costs and improve patient quality of life, when used for appropriate indications