Previous studies have shown that magnetic resonance cholangiography (MRC) produces similar levels of accuracy when used as a diagnostic tool for primary sclerosing cholangitis, when compared to Endoscopic retrograde cholangiopancreatography (ERCP).
Now it has been shown that MRC can also provide cost-saving benefits as well, when compared against ERCP.
Researchers determined the average cost per correct diagnosis using MRC or ERCP as the initial testing strategy for the diagnosis of primary sclerosing cholangitis (PSC).
The diagnostic test parameters determined prospectively from 73 patients with clinically suspected biliary disease were used to construct a decision analysis model.
ERCP was performed within 24 hours after MRC, with cost data derived from average Medicare reimbursement fee schedules.
|ERCP - $793.17 average cost per correct diagnosis|
MRC - $724.00 average cost per correct diagnosis
The prevalence of PSC in the study cohort was identified as 32% and the sensitivity and specificity of MRC for the diagnosis of PSC were 82% and 98%, respectively.
In the case of initial MRC the average cost of a correct diagnosis of PSC was $724.00. This cost included the cost of ERCP following a negative MRC examination.
This compared to an average cost of $793.17 for initial ERCP.
In the absence of biliary obstruction, the average cost per correct diagnosis of PSC was $549.34 with MRC versus $623.25 for ERCP.
The average cost of managing post-ERCP-related complications among patients with PSC was $2902.20 (range $1915.40 to $5031.54).
The researchers write that for ERCP to be the optimal initial test strategy, one of several factors would be required.
These would be a prevalence rate of PSC greater than 45%, MRC specificity less than 85% or a reduction in the average cost per diagnosis to $538.30.
The researchers conclude that MRC when used as the initial test strategy for diagnosing PSC has comparable accuracy to ERCP and results in cost savings.