Making Cost-Effectiveness Analyses Clinically Relevant: The Effect of Provider Expertise and Biliary Disease Prevalence on the Economic Comparison of Alternative Diagnostic Strategies
Section snippets
Decision Analysis
Decision analysis models (Figure 1, Figure 2) simulating the diagnosis and management of biliary disease were created with DATA 3.5 software (TreeAge Software, Williamstown, Mass) (4). The analysis was conducted from the perspective of a third-party payer—in this case, Medicare. The algorithms were designed to resemble clinical practice, with clinical decision making being based on the reported results of commonly available diagnostic tests. We analyzed the total costs per patient of the
References (19)
- et al.
Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common-bile duct lithiasis
Lancet
(1996) - et al.
Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? a prospective trial and cost analysis
Am J Gastroenterol
(2001) - et al.
Cost-effectiveness of saline-assisted hysterosonography and office hysteroscopy in the evaluation of postmenopausal bleeding: a decision analysis
Acad Radiol
(2001) - et al.
Risk factors for post-ERCP pancreatitis: a prospective, multicenter study
Gastrointest Endosc
(2001) - et al.
Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography?—a prospective controlled study
Gastrointest Endosc
(1999) - et al.
Prospective assessment of magnetic resonance cholangiopancreatography for noninvasive imaging of the biliary tree
Gastrointest Endosc
(2002) - et al.
Acute biliary pancreatitis: the roles of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography
Surgery
(1998) - et al.
Endoscopic ultrasonography versus cholangiography for the diagnosis of choledocholithiasis
Gastrointest Endosc
(1998) - et al.
The decision-making value of magnetic resonance cholangiopancreatography in patients seen in a referral center for suspected biliary and pancreatic disease
Am J Gastroenterol
(2001)
Cited by (23)
Endoscopic ultrasound avoids diagnostic ERCP among the ASGE high-risk group – Experience in an Asian population
2024, Journal of the Formosan Medical AssociationASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis
2019, Gastrointestinal EndoscopyCitation Excerpt :Additionally, this analysis assumed a very modest sensitivity of .4 for MRCP. MRCP was more cost-effective than EUS when the sensitivity of MRCP was assumed to be greater than .6.20 Additionally, the meta-analysis did not address adverse events.
Jaundice: Applying lessons from physiology
2014, Surgery (United Kingdom)Citation Excerpt :In cases of intermediate suspicion of biliary obstruction then MRCP or EUS is the investigation of choice prior to investigation of hepatic disorder In this patient population with a low disease prevalence, EUS is superior to MRCP in detecting bile duct stones <5 mm that would have been missed on a abdominal US or CT. EUS is most useful for confirming a normal biliary tree.29 In patients whom ERCP or PTC is the investigation of choice the default choice would be in favour of ERCP as it offers a broader range of interventional options than PTC.
Impact of provider-led, technology-enabled radiology management program on imaging
2013, American Journal of MedicineCitation Excerpt :First, it was beyond our scope to assess the impact of the radiology medical management program on appropriateness of testing. However, we designed the radiology medical management program interventions to specifically target inappropriate imaging studies, using evidence that was largely based on peer-reviewed literature, particularly research using decision analytic, decision rule, or cost-effective analysis.18-23 Therefore, on the basis of the intended target of the interventions, it is probable, although we could not confirm, that the observed use reduction was primarily in unnecessary studies.
Supported in part by the General Clinical Research Center of the University of Michigan, the Robert Wood Johnson Clinical Scholars Program, and the GE-AUR Research Fellowship.