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A Systematic Review and Economic Evaluation of Magnetic Resonance Cholangiopancreatography Compared to Diagnostic Endoscopic Retrograde Cholangiopancreatography

Kaltenthaler, E., Bravo-Vergel, Y., Chilcott, J., Thomas, S.M., Blakeborough, T., Walters, S. and Bouchier, H. (2004) A Systematic Review and Economic Evaluation of Magnetic Resonance Cholangiopancreatography Compared to Diagnostic Endoscopic Retrograde Cholangiopancreatography. Technical Report. Gray Publishing , Tunbridge Wells.

Full text available as:
Published Version: http://www.hta.ac.uk/1355

Abstract

Objectives:

To compare the clinical and costeffectiveness of magnetic resonance cholangiopancreatography (MRCP) with diagnostic endoscopic retrograde cholangiopancreatography (ERCP) for the investigation of biliary obstruction.

Data sources:

Electronic bibliographic databases, the reference lists of relevant articles and various health services research-related resources. Review methods: The data sources were searched and selected studies were assessed using quality criteria. In total, 28 prospective diagnostic studies were identified reporting several suspected conditions plus one of patient satisfaction. Analyses were then performed to establish sensitivities, specificities, likelihood ratios and confidence intervals. The relative cost-effectiveness of adopting MRCP scanning in the investigation of the biliary tree was undertaken using a probabilistic economic model.

Results:

The median sensitivity for choledocholithiasis (13 studies) was 93% and the median specificity 94%. The median likelihood ratio for a positive value was 15.75 and for a negative value 0.08. Reported sensitivities for malignancy were somewhat lower, ranging from 81 to 86%, and specificities ranged from 92 to 100%. There was some evidence that MRCP is an accurate diagnostic test in comparison to ERCP, although the quality of studies was moderate. Claustrophobia prevented at least some patients from having MRCP in ten of the 28 studies. The other 18 studies did not mention claustrophobia. The probability of avoiding unnecessary diagnostic ERCP is estimated at 30%. These patients could avoid the unnecessary risk of complications and death associated with diagnostic ERCP, and substantial cost saving would be gained. The overall expected cost saving associated with MRCP is £149; the overall expected gain in quality-adjusted life-year is estimated at 0.011.

Conclusions:

There is some evidence that MRCP is an accurate investigation compared with diagnostic ERCP, although the values for malignancy compared with choledocholithiasis were somewhat lower. The quality of studies was moderate. The limited evidence on patient satisfaction showed that patients preferred MRCP to diagnostic ERCP. The estimated clinical and economic impacts of diagnostic MRCP versus diagnostic ERCP are very favourable. The baseline estimate is that MRCP may both reduce cost and result in improved quality of life outcomes compared with diagnostic ERCP. Further research is suggested to compare MRCP and diagnostic ERCP with final diagnosis and also with the full range of target conditions; to examine patient satisfaction and ways of reducing problems with claustrophobia; to look at protocols to help identify who could most benefit from MRCP or ERCP; to assess the relative need and urgency of patient access to magnetic resonance imaging services, and also to determine how demand would affect availability and potential cost savings.

Item Type: Monograph (Technical Report)
Copyright, Publisher and Additional Information: Copyright: Queen’s Printer and Controller of HMSO 2005 HTA reports may be freely reproduced for the purposes of private research and study and may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Violations should be reported to hta@soton.ac.uk Applications for commercial reproduction should be addressed to HMSO, The Copyright Unit, St Clements House, 2-16 Colegate, Norwich, NR3 1BQ
Keywords: Cholestasis, Cholangiopancreatography, Magnetic resonance imaging, Endoscopic retrograde, Diagnosis, Systematic review, Economic evaluation
Institution: The University of Sheffield, The University of Leeds
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield)
The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Health Sciences (Leeds) > Centre for Health and Social Care (Leeds)
Depositing User: Diana Papaioannou
Date Deposited: 07 Dec 2006
Last Modified: 08 Feb 2013 16:50
Published Version: http://www.hta.ac.uk/1355
Status: Published
Publisher: Gray Publishing
Identification Number: ISSN 1366-5278
URI: http://eprints.whiterose.ac.uk/id/eprint/1792

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