Summary
This paper provides information on trends in the usage of endoscopy in Australia, and raises issues in relation to this technology. It is intended to serve as a basis for further discussion.
Trends in the incidence of endoscopic procedures
Commonwealth Department of Health statistics for endoscopy services for which medical benefits have been paid have been examined for the years 1980/81 - 1985/86 inclusive.
Endoscopic procedures increased by 77% (from 235 161 to 415 340 per annum) during the period.
Endoscopic procedures represented 0.34% of the total number of procedures recorded in 1985/86. Benefits paid totalled $58.5 M representing 2.2% of the total benefits paid for all services listed in the Medicare Benefits Schedule.
Gastrointestinal endoscopy had the largest growth, of 107% (from 113 692 to 235 571 procedures) and represented 57% of all endoscopy procedures in 1985/86.
There was a particularly rapid growth in the use of flexible endoscopes and in endoscopic therapeutic applications.
Providers of endoscopic services
The importance of training and certification of competency in the use of endoscopes has been highlighted by professional medical bodies and individuals.
The great majority of endoscopic procedures are performed by specialists. However, a significant proportion of the procedures in the lower gastrointestinal tract are being performed by general practitioners (13% in 1985/86).
Impact of endoscopy on alternative procedures
Growth in the use of endoscopy has not been matched by a fall in the number of barium studies, which still far exceed the number of equivalent gastrointestinal endoscopic examinations. However, the rate of increase for barium studies has slowed.
Future trends
Factors which could affect future trends in endoscopy usage include:
- Removal of the requirement for a diagnostic test before each prescription of the H-2 receptor antagonists cimetidine and ranitidine could tend to slow growth;
- Trends towards office endoscopy and endoscopy on GP referral, could tend to increase numbers of services.
Given the high incidence of bowel cancer, and the potential for prevention of this disease, the role of endoscopy in investigations of the lower gastrointestinal tract is likely to increase further.
Matters requiring further consideration
The relative roles of endoscopy and barium radiography in examinations of the gastrointestinal tract are in need of further clarification. Endoscopy is more expensive than barium radiography but there is growing evidence that the equivalent endoscopic investigations are more accurate.
Further evaluation of the benefits and cost effectiveness of endoscopy, particularly in gastroenterology, would be desirable.
The Panel suggests that the Royal Australasian College of Physicians, the Gastroenterological Society of Australia, the Royal Australasian College of Surgeons and the Royal Australasian College of Radiologists might consider cooperating in the development of guidelines on the most effective patterns of usage of endoscopy and barium radiography in gastrointestinal examinations.
Any guidelines developed should be made available to general practitioners, as well as to specialists, to assist them in decisions on referring patients for endoscopy.