title: Diagnosing Crohn's disease: an economic analysis comparing wireless capsule endoscopy with traditional diagnostic procedures.
abstract: The purpose of this study was to review economic considerations related to establishing a diagnosis of Crohn's disease, and to compare the costs of a diagnostic algorithm incorporating wireless capsule endoscopy (WCE) with the current algorithm for diagnosing Crohn's disease suspected in the small bowel. Published literature, clinical trial data on WCE in comparison to other diagnostic tools, and input from clinical experts were used as data sources for (1) identifying contributors to the costs of diagnosing Crohn's disease; (2) exploring where WCE should be placed within the diagnostic algorithm for Crohn's; and (3) constructing decision tree models with sensitivity analyses to explore costs (from a payor perspective) of diagnosing Crohn's disease using WCE compared to other diagnostic methods. Literature review confirms that Crohn's disease is a significant and growing public health concern from clinical, humanistic and economic perspectives, and results in a long-term burden for patients, their families, providers, insurers, and employers. Common diagnostic procedures include radiologic studies such as small bowel follow through (SBFT), enteroclysis, CT scans, ultrasounds, and MRIs, as well as serologic testing, and various forms of endoscopy. Diagnostic costs for Crohn's disease can be considerable, especially given the cycle of repeat testing due to the low diagnostic yield of certain procedures and the inability of current diagnostic procedures to image the entire small bowel. WCE has a higher average diagnostic yield than comparative procedures due to imaging clarity and the ability to visualize the entire small bowel. Literature review found the average diagnostic yield of SBFT and colonoscopy for work-up of Crohn's disease to be 53.87%, whereas WCE had a diagnostic yield of 69.59%. A simple decision tree model comparing two arms--colonoscopy and SBFT, or WCE--estimates that WCE produces a cost savings of 291dollars for each case presenting for diagnostic work-up for Crohn's. Sensitivity analysis varying diagnostic yields of colonoscopy and SBFT vs. WCE demonstrates that WCE is still less costly than SBFT and colonoscopy even at their highest reported yields, as long as the diagnostic yield of WCE is 64.10% or better. Employing WCE as a first-line diagnostic procedure appears to be less costly, from a payor perspective, than current common procedures for diagnosing suspected Crohn's disease in the small bowel. Although not addressed in this model, earlier diagnosis with WCE (due to higher diagnostic yield) also could lead to earlier management, improved quality of life and workplace productivity for people with Crohn's disease.
authors.affiliation: Department of Health Policy, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. niel.goldfarb@jefferson.edu
authors.forename: Neil I
authors.initials: NI
authors.lastname: Goldfarb
authors.forename: Laura T
authors.initials: LT
authors.lastname: Pizzi
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Fuhr
authors.forename: Christopher
authors.initials: C
authors.lastname: Salvador
authors.forename: Vanja
authors.initials: V
authors.lastname: Sikirica
authors.forename: Asher
authors.initials: A
authors.lastname: Kornbluth
authors.forename: Blair
authors.initials: B
authors.lastname: Lewis
mesh_terms: D000465:Algorithms; D003424:Crohn Disease / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology; D003663:Decision Trees; D003954:Diagnostic Services / Q000145:classification / Q000191:economics*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000191:economics* / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D017059:Models, Econometric; D014743:Videotape Recording