Cost-effectiveness of Endoscopy in Irritable Bowel Syndrome

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Abstract
IRRITABLE BOWEL syndrome (IBS) affects 15% to 20% of the US population,1 of whom only 30% seek medical attention for this condition.2-4 Its diagnosis is based primarily on the occurrence of typical symptoms.5 In the absence of any specific biochemical markers, symptoms constitute the only positive test modality for diagnosis of IBS. Studies6-9 have shown the sensitivity associated with typical symptoms to vary between 42% and 94% and the specificity to vary between 55% and 94%. To improve the diagnostic probability, physicians must resort to ruling out other potential organic diseases, such as inflammatory bowel disease, microscopic colitis, gastrointestinal infections, lactose intolerance, intestinal malabsorption, endocrine disorders, and colorectal cancer.10,11 This requires multiple laboratory tests, stool studies, radiologic small bowel follow-through, and flexible sigmoidoscopy or colonoscopy.11-13 The expenditures rise as a result of the multitude of tests necessary to rule out other medical conditions and to increase the certainty associated with the specific diagnosis of IBS. It was estimated that the excess medical cost for diagnosing IBS in the United States in 1992 was $8 billion.14 The present study focuses on the cost-effectiveness of endoscopic procedures in the workup of IBS. How much do flexible sigmoidoscopy and colonoscopy add to establishing a diagnosis of IBS and at what expense? The aim of our study was to assess the incremental cost-effectiveness of endoscopic procedures in the workup for IBS.

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