Cost minimization analysis comparing diagnostic strategies in unexplained pancreatitis

Area of Science:

• Gastroenterology
• Medical Diagnostics

Background:

• Idiopathic pancreatitis evaluation often involves ERCP and EUS.
• Comparative trials for these diagnostic modalities are scarce.
• The optimal endoscopic diagnostic strategy for idiopathic pancreatitis is undetermined.

Purpose of the Study:

• To compare the cost-effectiveness and diagnostic ability of EUS, ERCP, and cholecystectomy for idiopathic pancreatitis.
• To identify the ideal initial endoscopic diagnostic strategy for patients with idiopathic pancreatitis and an intact gallbladder.

Main Methods:

• A decision analysis model was developed using TreeAge software.
• The model evaluated three strategies: EUS, ERCP with manometry and bile aspiration, and laparoscopic cholecystectomy.
• Cost and diagnostic ability were analyzed for patients with a history of two idiopathic pancreatitis attacks and an in-situ gallbladder.

Main Results:

• Initial EUS was identified as the preferred diagnostic modality in the base case analysis.
• The expected cost for initial EUS was $4469, compared to $4615 for ERCP and $6268 for laparoscopic cholecystectomy.
• Cholecystectomy would only be preferred if its cost was below $1314 or if microlithiasis/sludge prevalence exceeded 80%; ERCP was preferred if prevalence was below 41%.

Conclusions:

• Endoscopic ultrasonography (EUS) is the least costly initial diagnostic test for evaluating idiopathic pancreatitis in patients with an intact gallbladder.
• This cost-minimization study provides evidence supporting EUS as the preferred initial diagnostic approach.