CT Imaging Cost-Effective for Those at Higher Risk of Crohn's

May offer alternative to small-bowel follow-through in patients with moderate to high suspicion of disease

WEDNESDAY, March 31 (HealthDay News) -- In patients with a moderate to high probability of having small-bowel Crohn's disease, computed tomographic enterography (CTE) is a more cost-effective follow-up test to ileocolonoscopy than a small-bowel follow-through (SBFT) study for diagnosing the disease, while the addition of capsule endoscopy as a third test is not cost-effective, even in those with high probability of the disease, according to a study in the March issue of Clinical Gastroenterology and Hepatology.

Barrett G. Levesque, M.D., of the Stanford University School of Medicine in Palo Alto, Calif., and colleagues developed a decision-analytic model to compare the lifetime costs and benefits of several diagnostic strategies for Crohn's disease, including ileocolonoscopy followed by either CTE or an SBFT study. Capsule endoscopy as a third test was also considered in cases when CTE or SBFT test results were negative. The pretest probability of Crohn's disease was defined as low (20 percent) or high (75 percent).

The researchers found that, in a patient with a moderate to high pretest probability of Crohn's disease, and a higher probability of isolated jejunal disease, follow-up with CTE had an incremental cost-effectiveness ratio of less than $54,000 per quality-adjusted life-year gained, which was superior to SBFT. The addition of capsule endoscopy as a third test cost more than $500,000 per quality-adjusted life-year gained in every scenario.

"The cost effectiveness of strategies depends critically on the pretest probability of Crohn's disease and if the terminal ileum is examined at ileocolonoscopy. CTE is a cost-effective alternative to SBFT in patients with moderate to high suspicion of small-bowel Crohn's disease. The addition of capsule endoscopy as a third test is not a cost-effective third test, even in patients with high pretest probability of disease," the authors write.

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