Date and Time
May 13, 2009
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Barrett Levesque - Stanford University

Background: The cost-effectiveness of alternative approaches to the diagnosis of Crohn's disease is unknown.

Objective: To evaluate the cost-effectiveness of ileocolonoscopy, small-bowel follow-through (SBFT), CT enterography (CTE), and capsule endoscopy for the diagnosis of small-bowel Crohn's disease.

Methods : A Markov model was developed to compare the life-time costs and benefits of each diagnostic strategy for a cohort of patients with suspected Crohn's disease using a societal perspective. Test characteristics were estimated from a recent 4-way prospective comparison. Probabilities, costs, and utilities were estimated from the literature and Medicare reimbursement rates. Effectiveness was measured in quality-adjusted life-years (QALYs) gained. Parameter assumptions were tested with sensitivity analyses.

Results: The cost-effectiveness of strategies depended critically on the pretest probability of Crohn's disease and whether or not the terminal ileum is successfully examined at ileocolonoscopy. After a successful ileocolonoscopy , CTE improved health outcomes at reduced costs relative to SBFT. If colonoscopy failed to intubate the terminal ileum, CTE as an alternative to SBFT cost less than $50,000 per QALY with moderate to high pretest probability of Crohn's disease.  The addition of capsule endoscopy as a third test requires a willingness-to-pay threshold $100,000/per QALY and high pre-test probability of disease.

Conclusions: CTE is a cost-effective alternative to SBFT in select patients with suspected small bowel Crohn's disease.  The addition of capsule endoscopy as a third test requires high suspicion of disease and high willingness-to-pay.