Cost-effectiveness analysis of endoscopic ultrasound versus magnetic resonance cholangiopancreatography in patients with suspected common bile duct stones
Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect...
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Published in | PloS one Vol. 10; no. 3; p. e0121699 |
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Main Authors | , , , |
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Language | English |
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23.03.2015
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Abstract | Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs.
This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones.
This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service (NHS) over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses.
Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively), with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively). Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK.
From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones. |
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AbstractList | This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones. This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service (NHS) over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses. Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively), with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively). Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK. From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones. Background Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs. Aim This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones. Methods This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service (NHS) over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses. Results Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively), with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively). Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK. Conclusion From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones. BackgroundPatients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs.AimThis study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones.MethodsThis study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service (NHS) over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses.ResultsUsing MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively), with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively). Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK.ConclusionFrom the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones. Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs. This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones. This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service (NHS) over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses. Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively), with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively). Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK. From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones. Background Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs. Aim This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones. Methods This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service (NHS) over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses. Results Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively), with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively). Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK. Conclusion From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones. |
Audience | Academic |
Author | Gurusamy, Kurinchi S Morris, Stephen Davidson, Brian R Sheringham, Jessica |
AuthorAffiliation | 1 Department of Applied Health Research, University College London, Gower Street, London, United Kingdom 2 Department of Surgery, University College London Medical School, 9th Floor, Royal Free Hospital, Rowland Hill Street, London, United Kingdom University of Calgary, CANADA |
AuthorAffiliation_xml | – name: 1 Department of Applied Health Research, University College London, Gower Street, London, United Kingdom – name: University of Calgary, CANADA – name: 2 Department of Surgery, University College London Medical School, 9th Floor, Royal Free Hospital, Rowland Hill Street, London, United Kingdom |
Author_xml | – sequence: 1 givenname: Stephen surname: Morris fullname: Morris, Stephen organization: Department of Applied Health Research, University College London, Gower Street, London, United Kingdom – sequence: 2 givenname: Kurinchi S surname: Gurusamy fullname: Gurusamy, Kurinchi S organization: Department of Surgery, University College London Medical School, 9th Floor, Royal Free Hospital, Rowland Hill Street, London, United Kingdom – sequence: 3 givenname: Jessica surname: Sheringham fullname: Sheringham, Jessica organization: Department of Applied Health Research, University College London, Gower Street, London, United Kingdom – sequence: 4 givenname: Brian R surname: Davidson fullname: Davidson, Brian R organization: Department of Surgery, University College London Medical School, 9th Floor, Royal Free Hospital, Rowland Hill Street, London, United Kingdom |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25799113$$D View this record in MEDLINE/PubMed |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist. Conceived and designed the experiments: SM KSG BD. Performed the experiments: SM. Analyzed the data: SM. Contributed reagents/materials/analysis tools: KSG BD. Wrote the paper: SM KSG JS BD. Contributed to interpretation of the analysis: JS. |
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Snippet | Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure... Background Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive... This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones. This study is a model based cost-utility... BACKGROUNDPatients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive... BackgroundPatients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive... Background Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive... |
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SubjectTerms | Bile Bile ducts Cholangiopancreatography, Magnetic Resonance - economics Cholecystectomy Complications Cost analysis Cost benefit analysis Decision Trees Economic aspects Endoscopic ultrasonography Endoscopy Endosonography - economics Expected values Gallbladder Gallstones - diagnosis Gallstones - diagnostic imaging Hospitals Humans Laparoscopy Longevity Magnetic resonance Medical diagnosis Medical research Mortality Pancreatitis Parameter sensitivity Patients Probability Quality of Life Resonance Risk reduction Sensitivity analysis Statistical analysis Ultrasonic imaging Ultrasound |
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Title | Cost-effectiveness analysis of endoscopic ultrasound versus magnetic resonance cholangiopancreatography in patients with suspected common bile duct stones |
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