Opportunities for Cost Reduction of Medical Care: Part 3

Monte Malach; William J. Baumol


J Community Health. 2012;37(4):888-896. 

In This Article

Gastrointestinal Disease

Laparoscopic abdominal surgery for the diagnosis and treatment of gall bladder disease,[27] bariatric weight loss surgery,[28] and the use of a biopsy capsule passed through an intestinal tube are all less invasive, safer, much less costly, and very effective means of diagnosing small bowel disease, as compared with open abdominal surgery.[29]

The frequency of colonoscopy for cancer screening, especially in patients over the age of 80, is often unnecessary, costly, and carries with it the risk of bowel perforation.[30] Colorectal cancer has been reported to be reduced in patients who take aspirin[31] and vitamin B6,[32] which also saves costs.

Each year in the United States, 20,000 new cases of liver cancer (hepatocellular carcinoma) are diagnosed. This is directly related to infection with the Hepatitis B or C viruses. Prevention of HBV (Hepatitis B virus) by vaccination of newborns and high-risk patients significantly reduces the incidence of liver cancer, thereby decreasing overall medical expenditures.[33]

The treatment of Clostridium difficile diarrhea and irritable bowel syndrome with rifaximin (Xifaxan®) has decreased hospital stays and associated costs.[34] Irritable bowel symptoms also have been reported to be decreased by increased physical activity.[35] Crohn's disease of the small and large intestines can be treated with infliximab (Remicade®), thereby resulting in shorter, less expensive hospital stays.[36] Hepatic encephalopathy treatment with rifaximin also has shortened hospital stay and costs.[37]


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