[Radiologic diagnosis of fistulas and abscesses in Crohn's disease: cost-effectiveness analysis of 2 different imaging strategies].
OBJECTIVE
To analyze cost-effectiveness of magnetic resonance imaging and conventional enteroclysis in the assessment of fistulas and abscesses in patients with Crohn's disease (CD).


METHODS
A decision analytic model was used to compare enteroclysis with MRI, performing a cost-effectiveness analysis of both diagnostic strategies. Data from 84 patients undergoing a clinical trial were used. Primary outcome was defined as one correctly diagnosed patient regarding Crohn's disease, fistulas, and abscesses, including true-positive and true-negative cases. Costs of the two procedures were estimated in German Marks (DM) using fee schedules. The influence of different definitions of effects was calculated. For all variables single and multiple sensitivity analyses were performed.


RESULTS
Incremental cost effectiveness of MRI vs. enteroclysis was 3,119.33 DM per one additional correctly diagnosed patient. The results of sensitivity analyses suggest that MRI use in certain patient subgroups (patients at higher prevalence of CD, fistulas, and abscesses) even becomes more cost-effective. In this case one additional effect could be gained below 1,650 DM.


CONCLUSIONS
From an economic perspective, decision makers should consider the use of MRI in the work-up of patients with Crohn's disease as an efficient procedure under certain conditions. To support treatment policies for physicians or insurance coverage of certain diagnostic strategies the costs possibly saved with MRI should also be considered.
Rösch
M
M
Abteilung Gesundheitsökonomie, Universität Ulm. margrit.roesch@mathematik.uni-ulm.de
Rieber
A
A
Leidl
R
R
D018784:Abdominal Abscess / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001466:Barium Sulfate; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003424:Crohn Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000191:economics; D004733:Enema; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011859:Radiography
D001466:Barium Sulfate