title: Comparison Costs of ERCP and MRCP in Patients with Suspected Biliary Obstruction Based on a Randomized Trial.
abstract: BACKGROUND
  The optimal management of patients with suspected biliary obstruction remains unclear, and includes the possible performance of magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  OBJECTIVE
  To complete a cost analysis based on a medical effectiveness randomized trial comparing an ERCP-first approach with an MRCP-first approach in patients with suspected bile duct obstruction.
  
  
  METHODS
  The management strategies were based on a medical effectiveness trial of 257 patients over a 12-month follow-up period. Direct and indirect costs were included, adopting a societal perspective. The cost values are expressed in 2012 Canadian dollars.
  
  
  RESULTS
  Total per-patient direct costs were Can$3547 for ERCP-first patients and Can$4013 for MRCP-first patients. Corresponding indirect costs were Can$732 and Can$694, respectively. Causes for differences in direct costs included a more frequent second procedure and a greater mean number of hospital days over the year in patients of the MRCP-first group. In contrast, it is the ERCP-first patients whose indirect costs were greater, principally due to more time away from activities of daily living. Choosing an ERCP-first strategy rather than an MRCP-first strategy saved on average Can$428 per patient over the 12-month follow-up duration; however, there existed a large amount of overlap when varying total cost estimates across a sensitivity analysis range based on observed resources utilization.
  
  
  CONCLUSIONS
  This cost analysis suggests only a small difference in total costs, favoring the ERCP-first group, and is principally attributable to procedures and hospitalizations with little impact from indirect cost measurements.
authors.affiliation: Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, QC, Canada.
authors.forename: Viviane
authors.initials: V
authors.lastname: Adam
authors.affiliation: Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, QC, Canada.
authors.forename: Mamatha
authors.initials: M
authors.lastname: Bhat
authors.affiliation: Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, QC, Canada.
authors.forename: Myriam
authors.initials: M
authors.lastname: Martel
authors.affiliation: San Jose Gastroenterology, San Jose, CA, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: da Silveira
authors.affiliation: Division of Diagnostic Radiology, McGill University Health Center, McGill University, Montreal, QC, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Reinhold
authors.affiliation: Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, QC, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Valois
authors.affiliation: Division of Surgery, McGill University Health Center, McGill University, Montreal, QC, Canada.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Barkun
authors.affiliation: Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, QC, Canada; Division of Epidemiology, Biostatistics and Occupational Health, McGill University Health Center, McGill University, Montreal, QC, Canada. Electronic address: alan.barkun@muhc.mcgill.ca.
authors.forename: Alan N
authors.initials: AN
authors.lastname: Barkun
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics*; D049448:Cholangiopancreatography, Magnetic Resonance / Q000191:economics*; D002779:Cholestasis / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011792:Quebec; D013997:Time Factors
keywords: ERCP; MRCP; biliary obstruction; costs