Cost-Effectiveness of the Sucralfate Technetium 99m isotope Labelled Esophageal Scan to Assessesophageal Injury in Children after Caustic Ingestion

Abstract

Background: Ingestion of caustic material by children is a considerable health problem. The 99mTc-labelled sucralfate esophageal scan proved to be an accurate method to identify injury to the esophagus after caustic substance ingestion. The purpose of this study was to calculate the cost-effectiveness of a sucralfate scan as compared to the gold standard of using endoscopy under general anesthesia. A secondary outcome was to assess the positive predictive value of the sucralfate scan.
Methods: A 10-year retrospective medical folder audit was conducted of all children admitted to our hospital with a history of caustic ingestion who underwent a sucralfate scan to identify evidence of caustic esophageal injury/inflammation. The patients who had a negative sucralfate scan were assessed as having no significant injury and were discharged without further investigation or management. The patients with a positive result went for a subsequent endoscopy.
Results: 234 patients were included. The total costs saved by performing a sucralfate scan only were R 446, 964.00 (South African Rand) in 234 patients. The positive predictive value of performing a sucralfate scan is 47.3%.
Conclusion: A sucralfate scan as primary diagnostic method for caustic injury proved to be cost-effective and with less chance of complications.