COSTS OF TREATING NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING IN CANADIAN HOSPITALS - RESULTS FROM THE REGISTRY ON UPPER GASTROINTESTINAL BLEEDING AND ENDOSCOPY (RUGBE)

YM Gagnon¹, RA Enns², AR Levy^1,2,3 and RUGBE investigators⁴

¹Occam Research & Consulting Inc, Vancouver, British Columbia; ²University of British Columbia (UBC); ³CHEOS, Vancouver, British Columbia; and 4all other participating hospitals in Canadian Registry of Upper Gastrointestinal Bleeding undergoing Endoscopy

PURPOSE: The economic burden of non-variceal upper gastrointestinal bleeding is substantial because the high incidence of occurrence. Estimates from the United States showed that the average cost per person was US$5,000 in 1996. However these costs in Canada are unknown. The objective of this study was to determine the cost of health resources used to treat persons with non-variceal UGI bleeding in Canadian hospitals.
METHODS: We used data from a registry of 1,877 subjects treated for acute UGI bleeding, called the Registry on Upper Gastrointestinal Bleeding and Endoscopy (RUGBE), collected in 18 Canadian hospitals in 2000 and 2001. We extracted subject-level data on health resources utilization including diagnostic testing, hospital procedures, in-hospital physician visits, hospital length of stays and medications. Unit costs were derived from a Canadian list of provincial costs, physician payment schedules, hospital pharmacies and provincial drug formularies. For each bleeding episode and subject, we calculated the total cost of health resources used and estimated the average treatment cost per bleeding event and per subject. Costs were compared according to subject characteristics including age, sex, co-morbidities and known etiologic factors including presence of H. pylori and use of non-steroidal anti-inflammatory drugs, corticosteroids and acetylsalicylic acid. All costs are reported in 2001 Canadian dollars.
RESULTS: The mean treatment cost per bleeding episode was $3,273 (standard deviation (SD): ± $3,475) and the mean cost per subject $4,346 (SD: ± $3,997). Mean costs were higher for subjects over age 65 years ($4,737) compared to subjects aged 18 to 65 years ($3,782) (P < 0.001). In a multivariate analysis, age and co-morbidities were associated with higher treatment costs while previous anti-inflammatory drug use and gender were not. The main cost drivers were hospitalization cost and procedures professional fees.
CONCLUSION: These data indicate that the costs of treating non-variceal UGI bleeding are relatively high. Improvements in early diagnosis and therapy that reduce the rates of rebleeds and need for surgical procedures are likely to be cost-effective and may even be cost-saving.

Acknowledgements: Financial support for the Registry on Upper Gastrointestinal Bleeding and Endoscopy was received from Byk Canada Inc.