Cost-Effective Means of Diagnosing and Following Benign and Malignant Gastric Ulcers

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Abstract
To define the most cost-effective means of diagnosing and following gastric ulcers, both benign and malignant, the University of Utah Medical Center (UUMC) [USA] experience between Sept. 1980 and Oct. 1983 was reviewed. Endoscopy (EGD) was utilized in the initial evaluation process in 96% of patients. Follow-up was performed by either a combination of EGD and double contrast upper GI [gastrointestine] (DCUGI) or EGD alone. Diagnostic and follow-up modality had no effect on survival. The high-frequency use of EGD for gastric ulcer management is not cost-effective. An algorithm in which EGD would be used only following failure either to demonstrate characteristic benign appearance on DCUGI or inadequate healing following therapeutic trial is suggested. A theoretical net savings of 55% is calculated by retrospective application of the algorithm to the UUMC experience; 30% savings is realized for diagnosis and 81% for follow-up. If adopted on a national scale, the algorithm proposed may result in a significant savings in health-care cost.