Economic evaluation of MR cholangiopancreatography compared to diagnostic ERCP for the investigation of biliary tree obstruction

Abstract

Background

Use of magnetic resonance cholangiopancreatography (MRCP) for confirmation of presence of biliary obstruction is virtually risk-free. However, unlike diagnostic endoscopic retrograde cholangiopancreatography (ERCP), no therapeutic option can be offered simultaneously with MRCP. The aim of the study is to assess the cost-effectiveness of MRCP when compared with the conventional practice of diagnostic ERCP for the investigation of biliary obstruction in adults.

Methods

Cost-effectiveness analysis from the perspective of the health care provider. Sensitivity analysis includes presentation of a family of cost effectiveness acceptability curves and the impact of different risks of common bile duct stones associated with ultrasound and liver function test results. The main outcome measure is cost per quality adjusted life year (QALY).

Results

Baseline results, at 37% probability of common bile duct stones, show that MRCP is the dominant strategy, with expected savings of £149 (£325 to −£15) and expected QALY gain of 0.011 (0–0.030) per case. The probability of avoiding unnecessary therapeutic ERCP is 30%. For patients at high risk of common bile duct stones (probability >60%) ERCP is the preferable strategy.

Conclusions

The baseline estimate is that MRCP would be both cost saving and would result in improved quality of life outcomes compared to diagnostic ERCP, but its potential sources of economic benefit are highly dependent on access to, and waiting lists for adequate MRI technology at hospital level.