Implementierung der Ergebnisse einer Kosten-Effektivitätsanalyse für die endoskopische Injektionstherapie bei oberer gastrointestinaler Blutung

Introduction: A previous upper gastrointestinal bleeding trial [5] had shown that patients treated with repeated fibrin glue injection for upper gastrointestinal bleeding have significantly less rebleeding than those treated with polidocanol. Our aim was to analyze if repeated fibrin glue injection is cost-effective and to investigate how implementation of new research results changes physicians attitudes. Methods: A random sample of 5 hospitals from the previous study [5] was drawn. Cost identification and follow-up data on 319 patients (154 in the polidocanol group, 165 in the fibrin glue group) were collected. An incremental cost-effectiveness analysis and comparison of outcomes was performed by x 2-tests and Kaplan-Meier survival analysis. A survey with a questionnaire on local guidelines for management of ulcer bleeding and a qualitative analysis of its results were conducted in the 5 hospitals. Results: The cost for the prevention of one additional rebleeding by repeated FG treatment amounts to 14,316 EUR (incremental cost-effectiveness ratio). There were no significant differences in length of stay in ICU and hospital. The physicians did not change their management plans for patients with upper gastrointestinal bleeding. In the survey it was seen that other factors like local guidelines, attitudes towards new treatment options and easiness of handling of drugs are more important factors for a behavioral change of the doctors than a result of a single study. Conclusions: A significantly lower rebleeding rate in the fibrin glue group did not result in significant differences in length of ICU or hospital stay.