Family planning in inflammatory bowel disease: childlessness and disease-related concerns among female patients.

OBJECTIVE: Inflammatory bowel disease (IBD) frequently affects women when family planning and pregnancy (FPP) are important issues. This survey aimed to identify patients with an increased need for medical counselling. PATIENTS AND METHODS: An internet-based questionnaire was offered to women with IBD. Characteristics in terms of FPP were analysed with respect to sociodemographic and disease-related factors. RESULTS: Childlessness was frequently reported (64.8% of 443 participants). In women older than 35 years with IBD, childlessness was significantly more prevalent than that in the general population (36.7 vs. 22.9%, odds ratio=1.9, P<0.001). Overall, 44.2% of the women were satisfied with counselling in general, and only 27.3% with the specific advice on FPP. Women younger than 25 years were rarely satisfied with the advice in terms of FPP (18.2%) and demanded an intensified counselling (44.6%). Frequent concerns were the heritability of IBD (all women, 59.2%; mothers, 51.5%; childless, 62.5%, P<0.01), medication during FPP (44.7, 26.1, 52.4%, P<0.01) and miscarriage (38.9, 16.8, 48.7%, P<0.01). CONCLUSION: The prevalence of childlessness in women with IBD compared with the general population increases with age. FPP-related worries, especially in terms of heredity, medication and miscarriage, are associated with an increased risk for childlessness. The results underline the importance of qualified counselling as early as possible during the course of the disase.

Minimizing procedural cost in diagnosing small bowel bleeding: comparison of a strategy based on initial capsule endoscopy versus initial double-balloon enteroscopy.

INTRODUCTION: Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) detect small bowel bleeding with equal diagnostic yield. We aimed to detect factors that influence procedural cost of CE and DBE in diagnosing and treating small bowel bleeding, and to compare them with reimbursement. METHODS: A cost model analysed procedural cost for diagnostic CE versus diagnostic, unidirectional DBE(scenario 1) and CE plus directed therapeutic DBE(positive findings in CE) versus unidirectional diagnostic plus therapeutic DBE (scenario 2). The frequency of investigations per annum (p.a.) at which cost per procedure is equalized (break-even point) was determined for CE versus DBE. A retrospectively collected cohort of patients was used to validate the cost model and to compare procedural costs with reimbursement (German diagnosis related groups, G-DRG). RESULTS: The break-even point at which cost per procedure is equalized for CE versus DBE was reached at 100 procedures p.a. in scenario 1 and 79 in scenario 2 for a rate of therapeutic enteroscopy of 14%, and 27 for a therapeutic enteroscopy rate of 30%. Personnel cost, procedure time,procedures p.a. and the rate of therapeutic enteroscopy had a major influence on procedural cost. In this patient cohort, the 'CE-first' and the 'DBE-first' strategies produced procedural costs of pound sterling 830 and pound sterling 1,076 per patient to attain a diagnosis, and pound sterling 1,042 versus pound sterling 1,181 to achieve therapeutic enteroscopy, respectively. For this cohort, potential reimbursement was pound sterling 2,320 and pound sterling 3,047 for the 'CE-first' and the 'DBE-first' strategies, respectively (G-DRG). CONCLUSION: Workflow management of CE versus DBE should consider frequency of investigations p.a. and probability for therapeutic enteroscopy to minimize procedural costs. The cost of DBE increases with less frequent or time-consuming investigations; CE is more robust with regard to these factors. From a third-party payer perspective, a strategy incorporating CE seems to minimize costs in G-DRG.