SHM Converge Scientific Abstract ePoster Gallery-Cost-Effectiveness of Early Egd in Non-Variceal Upper Gi Bleeding: An Augmented Inverse Probability Weighting Analysis

Cost-Effectiveness of Early Egd in Non-Variceal Upper Gi Bleeding: An Augmented Inverse Probability Weighting Analysis

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This study used 2019 National Inpatient Sample data to examine whether early endoscopy (EGD within 1–2 days of admission) improves resource use in adults hospitalized non-electively with non-variceal upper GI bleeding. Using a doubly robust augmented inverse probability weighting approach, the authors estimated the average treatment effect of early EGD versus delayed EGD on log-transformed hospital charges, with sensitivity analyses for a stricter comparison (day 3 only), mortality, and unmeasured confounding using an E-value.<br /><br />Among 198,015 admissions, 71.7% received early EGD and 28.3% had delayed EGD. Patients with delayed EGD were generally older and had more comorbidity burden, more weekend admissions, and more intensive hospital use. Early EGD was associated with lower total charges, shorter length of stay, and no meaningful change in mortality.<br /><br />Compared with delayed EGD, early EGD reduced charges by $8,515 per patient (18.3%) and reduced length of stay by 1.73 days; mortality difference was negligible (risk difference 0.1%). Compared with a one-day delay, early EGD still lowered charges by $3,745 (9.0%) and shortened stay by 0.92 days, again without a mortality benefit or harm.<br /><br />The estimated E-value was 1.75, suggesting that only moderately strong unmeasured confounding would be needed to explain away the cost-effectiveness finding. Based on these results, the authors conclude that hospitals should invest more resources to provide guideline-concordant early EGD for non-variceal upper GI bleeding, as delayed procedures may lead to substantial avoidable spending.

Asset Subtitle

Omer Hamad

Meta Tag

Author List Hirotaka Kato, Omer Hamad

Category Research

Concept Early EGD

Concept Nonvariceal Bleeding

Concept Augmented Inverse Probability Weighting

Concept Guideline-Concordant Timing

Concept Average Treatment Effect

Distinguished Non-Finalist

Presenter Organization University of Kentucky College of Medicine

Presenting Author Omer Hamad

Track Outcomes Research

Keywords

early endoscopy

EGD

non-variceal upper GI bleeding

hospital charges

length of stay

resource utilization

doubly robust weighting

National Inpatient Sample

mortality

unmeasured confounding

Early EGD

Nonvariceal Bleeding

Augmented Inverse Probability Weighting

Guideline-Concordant Timing

Average Treatment Effect