Use of a decision-analytic model to support the use of a new oral US contrast agent in patients with abdominal pain.
OBJECTIVE
The authors performed this study to compare the cost and diagnostic abilities of ultrasound (US) performed with and without the use of an oral contrast material recently approved by the U.S. Food and Drug Administration.


METHODS
An interactive decision-analytic model was constructed to compare US performed with and without contrast material (SonoRx; Bracco Diagnostics) for the evaluation of patients with abdominal pain who were suspected of having pancreatic disease. The model considered all resources that might be used to evaluate a patient suspected of having pancreatic disease (eg, US, computed tomography [CT], endoscopic retrograde cholangiopancreatography, fine-needle aspiration biopsy, and open biopsy). The literature and an expert panel were the clinical data sources. Cost estimates were based on Medicare and non-Medicare reimbursements. The primary cost-effectiveness measure was the cost to achieve a diagnosis.


RESULTS
SonoRx-enhanced US was less expensive than unenhanced US ($714 vs $808, respectively, with Medicare costs; $1,612 vs $1,878, respectively, with non-Medicare costs) and as effective (0.785 vs 0.782, respectively). SonoRx-enhanced US was more cost-effective than unenhanced US ($909 vs $1,034, respectively, with Medicare costs; $2,052 vs $2,401, respectively, with non-Medicare costs). This relationship was maintained throughout extensive sensitivity analyses.


CONCLUSIONS
SonoRx-enhanced US is more cost-effective than unenhanced US, primarily because it avoids the need for CT. CT may be avoided owing to the higher probability of obtaining optimal US scans with oral contrast material.
Department of Radiology, University of Missouri Hospital and Clinics, Columbia 65212, USA.
R L
RL
Bree
R J
RJ
Arnold
K G
KG
Pettit
D J
DJ
Kaniecki
C
C
O'haeri
N D
ND
LaFrance
A L
AL
Toaff
D015746:Abdominal Pain / Q000000981:diagnostic imaging* / Q000191:economics / Q000209:etiology; D000284:Administration, Oral; D002482:Cellulose / Q000008:administration & dosage* / Q000191:economics; D003287:Contrast Media / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003937:Diagnosis, Differential; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D018803:Models, Economic; D010182:Pancreatic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000191:economics; D012680:Sensitivity and Specificity; D012841:Simethicone / Q000008:administration & dosage* / Q000191:economics; D014463:Ultrasonography
D003287:Contrast Media; C120539:SonoRx; D012841:Simethicone; D002482:Cellulose