Tai Foong Way David, Healy Ailish, Thokala Praveen, Chetcuti Zammit Stefania, Sidhu Reena, McAlindon Mark
Academic Unit of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield, UK.
Health Economics and Decision Science, The University of Sheffield School of Health and Related Research, Sheffield, UK.
Frontline Gastroenterol. 2022 Nov 4;14(4):300-305. doi: 10.1136/flgastro-2022-102256. eCollection 2023.
Conventional oral upper gastrointestinal (GI) endoscopy can obe uncomfortable. By comparison, transnasal endoscopy (TNE) and magnet assisted capsule endoscopy (MACE) have superior tolerability. A cost comparison of competing upper GI endoscopic modalities have yet to be performed.
We performed a cost comparison study of oral, TNE and MACE by a combination of activity-based costing and averaging of fixed costs over 24 481 upper GI endoscopies performed for dyspepsia over a 10-year period.
On average, 9.4 procedures were performed daily. TNE was cheapest at €125.90 per procedure, costing 30% less than oral endoscopy at €184.10 and threefold cheaper than MACE at €407.10. Flexible endoscope reprocessing cost €53.80. TNE was cheaper than oral endoscopy as sedation was not required. Oral endoscopies have a further rate of infectious complications, estimated to cost €16.20 per oral procedure in inpatient admissions. Oral and TNE equipment are more expensive to purchase and maintain than MACE costing €79 330 and €81 819, respectively compared with MACE at €15 420 per annum. However, capsule endoscopes cost significantly more per procedure at €369.00 than the consumables for flexible endoscopy (per oral €12.30, TNE €5.30).
TNE cost less to perform than conventional per oral endoscopy. The cost of capsule endoscopes will need to be reduced significantly if routine use is to be expected.
传统的经口上消化道内镜检查可能会让人感到不适。相比之下，经鼻内镜检查（TNE）和磁控胶囊内镜检查（MACE）具有更好的耐受性。目前尚未对竞争性的上消化道内镜检查方式进行成本比较。
我们通过基于活动的成本核算以及对10年内为消化不良患者进行的24481例上消化道内镜检查的固定成本进行平均，对经口、TNE和MACE进行了成本比较研究。
平均每天进行9.4例检查。TNE最便宜，每次检查费用为125.90欧元，比经口内镜检查的184.10欧元便宜30%，比MACE的407.10欧元便宜三倍。软性内镜再处理成本为53.80欧元。由于不需要镇静，TNE比经口内镜检查便宜。经口内镜检查有更高的感染并发症发生率，据估计住院患者每次经口检查的成本为16.20欧元。经口和TNE设备的购买和维护成本比MACE更高，经口和TNE设备每年分别为79330欧元和81819欧元，而MACE每年为15420欧元。然而，胶囊内镜每次检查的成本为369.00欧元，远高于软性内镜检查的耗材成本（经口检查为12.30欧元，TNE为5.30欧元）。
TNE的实施成本低于传统的经口内镜检查。如果期望常规使用，胶囊内镜的成本需要大幅降低。
