Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, 111 Brewster St., Pawtucket, RI 02860, USA.
J Med Econ. 2011;14(3):279-87. doi: 10.3111/13696998.2011.571328. Epub 2011 Apr 1.
Gastrointestinal (GI) blood loss is a common medical condition which can have serious morbidity and mortality consequences and may pose an enormous burden on healthcare utilization. The purpose of this study was to conduct a systematic review to evaluate the impact of upper and lower GI blood loss on healthcare utilization and costs.
We performed a systematic search of peer-reviewed English articles from MEDLINE published between 1990 and 2010. Articles were limited to studies with patients ≥18 years of age, non-pregnant women, and individuals without anemia of chronic disease, renal disease, cancer, congestive heart failure, HIV, iron-deficiency anemia or blood loss due to trauma or surgery. Two reviewers independently assessed abstract and article relevance.
Eight retrospective articles were included which used medical records or claims data. Studies analyzed resource utilization related to medical care although none of the studies assessed indirect resource use or costs. All but one study limited assessment of healthcare utilization to hospital use. The mean cost/hospital admission for upper GI blood loss was reported to be in the range $3180-8990 in the US, $2500-3000 in Canada and, in the Netherlands, the mean hospital cost/per blood loss event was €11,900 for a bleeding ulcer and €26,000 for a bleeding and perforated ulcer. Mean cost/ hospital admission for lower GI blood loss was $4800 in Canada, and $40,456 for small bowel bleeding in the US.
Our findings suggest that the impact of GI blood loss on healthcare costs is substantial but studies are limited. Additional investigations are needed which examine both direct and indirect costs as well as healthcare costs by source of GI blood loss focusing on specific populations in order to target treatment pathways for patients with GI blood loss.
胃肠道（GI）出血是一种常见的医学病症，可能会导致严重的发病率和死亡率，并可能对医疗保健的利用造成巨大负担。本研究的目的是进行系统评价，以评估上消化道和下消化道出血对医疗保健利用和成本的影响。
我们对 1990 年至 2010 年间发表的 MEDLINE 同行评审英文文章进行了系统搜索。文章仅限于研究年龄≥18 岁、非孕妇、无慢性病性贫血、肾脏疾病、癌症、充血性心力衰竭、HIV、缺铁性贫血或因创伤或手术导致失血的患者。两位审稿人独立评估了摘要和文章的相关性。
纳入了 8 篇回顾性文章，这些文章使用了医疗记录或索赔数据。尽管没有研究评估间接资源利用或成本，但这些研究分析了与医疗保健相关的资源利用。除了一项研究外，所有研究都将医疗保健利用的评估仅限于住院治疗。在美国，上消化道出血的平均住院费用/住院费用为 3180-8990 美元，在加拿大为 2500-3000 美元，在荷兰，每发生一次出血性溃疡的平均住院费用为 11900 欧元，每发生一次出血和穿孔性溃疡的平均住院费用为 26000 欧元。加拿大下消化道出血的平均住院费用/住院费用为 4800 美元，美国小肠出血的平均住院费用/住院费用为 40456 美元。
我们的研究结果表明，GI 出血对医疗保健成本的影响是巨大的，但研究有限。需要进行更多的研究，以检查直接和间接成本以及按 GI 出血来源划分的医疗保健成本，重点关注特定人群，以便为 GI 出血患者制定治疗途径。
