We report the clinical outcomes and direct medical costs of 155 patients with severe peptic ulcer hemorrhage and a nonbleeding visible vessel at emergency endoscopy treated with endoscopic hemostasis or medical-surgical therapy.
In two consecutive, prospective, randomized, controlled trials, patients were randomly assigned to endoscopic hemostasis (heater probe, bipolar electrocoagulation, or injection sclerosis) or medical-surgical treatment.
Study endpoints included the incidence of severe ulcer rebleeding and emergency surgery, length of hospital stay, blood transfusion requirements, mortality rate, and direct costs of utilized health care.
Direct medical costs were estimated using combined fixed and variable institutional costs for consumed resources and Medicare reimbursement rates.
Compared with medical-surgical treatment, endoscopically treated patients had significantly lower rates of severe ulcer rebleeding (p=0.004), emergency surgery (p=0.002 and p=0.019,0.024), and blood transfusions (p=0.025).
Observed inter-trial differences in ulcer rebleeding rates may be partially explained in a multivariate model by covariates of comorbid disease and inpatient ulcer bleeding.
In both trials, length of hospital stay, mortality rates, and treatment-related complications were similar. (...)
Mots-clés Pascal : Ulcère, Gastroduodénal, Complication, Hémorragie, Gastrointestinal, Varice, Traitement, Hémostase, Gastroscopie, Evaluation performance, Coût, Evolution, Etude comparative, Homme, Appareil digestif pathologie, Estomac pathologie, Intestin pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Veine pathologie, Endoscopie, Chimiothérapie, Economie santé
Mots-clés Pascal anglais : Ulcer, Gastroduodenal, Complication, Hemorrhage, Gastrointestinal, Varix, Treatment, Hemostasis, Gastroscopy, Performance evaluation, Costs, Evolution, Comparative study, Human, Digestive diseases, Gastric disease, Intestinal disease, Cardiovascular disease, Vascular disease, Venous disease, Endoscopy, Chemotherapy, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0016747
Code Inist : 002B02H. Création : 31/05/1999.