Capsule endoscopy in suspected small bowel Crohn’s disease: Economic impact of disease diagnosis and treatment

Table 1 Aggregate charges for each therapeutic grouping used in model

Procedure	Group 1	Group 2	Group 3
Base charge1	$49 074	$13 258	$8295
Monoclonal therapy2	-	$16 250	-
Colon/SBFT3	$50 253	$30 687	$9474
CE4	$50 612	$31 046	$9833

¹Groups 1, 2, and 3 base annual charges adjusted for inflation from Feagan et al by consumer price index (CPI) to estimate 2007 charges;

²Base annual charge for monoclonal (Infliximab) therapy for Crohn’s disease was estimated as $65 000. We assumed 25% of patients requiring aggressive medical management were treated with this agent and adjusted Group 2 by $16 250;

³Colon/SBFT procedure charge $1179;

⁴CE procedure charge $1538. SBFT: Small bowel follow-through; CE: Capsule endoscopy.

Table 2 Procedure charges used for the model according to the 2007 medicare fee schedule

HCPCS code	Procedure	Reimbursement	Colonoscopy w/SBFT	Capsule endoscopy
45380	Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple	$491.15	x	x
74249	Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with small intestine follow-through	$177.87	x
88305	Level IV-surgical pathology, gross and microscopic examination	$115.38	x
88323	Consultation and report on referred material requiring preparation of slides	$150.09	x
91110	Gastrointestinal tract imaging, intraluminal (e.g. capsule endoscopy), esophagus through ileum, with physician interpretation and report	$950.00		x
99242	Office (gastroenterologist) consultation (Level 2)	$97.37	x	x
		Additional Medications1	$50
		Total	$1179.00	$1538.00

¹Additional medications: Sedatives, anxiolytics, and anti-emetics administered during a routine procedure.

Table 3 Model inputs

Input	Mean (range)	Ref.
CE sensitivity (sens_CE)	0.96 (0.80-0.99)	[3,14-17,26,27]
CE specificity (spec_CE)	0.87 (0.80-0.99)	[3,14-17,26,27]
SBFT sensitivity (sens_SBFT)	0.96 (0.80-0.99)	[3,14-17,26,27]
SBFT specificity (spec_SBFT)	0.81(0.80-0.99)	[3,14-17,26,27]
Disease present/absent	0.10/0.90	[1,2,4]
Hospitalization frequency (Group 1)	0.19	[18]
Aggressive medical management frequency (Group 2)	0.05	[18]
Other management frequency (Group 3)	0.76	[18]