Impact of reimbursement policy in Belgium on the referral pattern and diagnostic yield of capsule endoscopy. A single-centre study.

INTRODUCTION

Since the first of July 2008, capsule endoscopy (CE) is partially reimbursed for patients with obscure gastrointestinal bleeding (OGIB).

OBJECTIVE

To evaluate the impact of reimbursement of CE on the referral pattern and the diagnostic yield of CE.

METHODS

We retrospectively selected data from patients who underwent a CE in the University Hospital of Ghent between July 2002 and June 2009. Following data were analysed: number of CEs, indication, number of transfusion-dependent patients, haemoglobin level and relevance of the CE findings.

RESULTS

There was an increase in the number of patients referred for CE after the first of July 2008. Simultaneously, the number of relevant findings was decreasing. Between July 2002 and June 2003, 66.7% of the capsule endoscopies showed relevant bowel lesions. Over the last 2 years, the diagnostic yield has been decreasing to 40.5% in the period July 2007-June 2008 and only 30.2% in the period July 2008-June 2009. Transfusion need and haemoglobin level at the moment of CE had a significant influence on the diagnostic yield (P < 0.001 for both parameters).

CONCLUSIONS

The number of patients referred for CE has risen since the reimbursement of CE. However, there is a trend towards referral of less severe bleeders, with less transfusion need and a higher haemoglobin level. This significantly lowers the diagnostic yield of CE.