Objective: To evaluate accuracy and cost of non-invasive diagnostic strategies including magnetic resonance imaging, intestinal ultrasonography, ileocolonoscopy and video-capsule endoscopy in suspected Crohn's disease. Methods: A decision-analytic model was used to assess the costs in low (25%), intermediate (50%) or high (75%) pre-test probability of Crohn's disease. Based on the published accuracy of diagnostic modalities and Bayes' rule, we calculated post-test probability of Crohn's disease using different strategies, starting from ileocolonoscopy, ultrasonography or magnetic resonance. Each strategy was considered successful when post-test probability was > 95% or <. 5%. Results: With low pre-test probability, only ileocolonoscopy as the first investigation could exclude or confirm Crohn's disease while a normal ultrasonography may exclude Crohn's disease. With high pre-test probability, ileocolonoscopy or ultrasonography as the first test may confirm Crohn's disease, but at least 3 negative tests are required to exclude Crohn's disease.The cost to diagnose one patient was cheapest utilising an ultrasonography-based strategy both in low (ultrasonography €1076; ileocolonoscopy €2005; magnetic resonance €4515) and high pre-test probability of Crohn's disease (ultrasonography €321; ileocolonoscopy €712; magnetic resonance €1412). Conclusion: The accuracy and cost of these strategies depend on pre-test probability of Crohn's disease and vary according to the first test used. Ileocolonoscopy plus ultrasonography is the most accurate and less expensive initial diagnostic strategy.
Accuracy and cost of diagnostic strategies for patients with suspected Crohn's disease / G. Maconi, E. Bolzoni, A. Giussani, A.B. Friedman, P. Duca. - In: JOURNAL OF CROHN'S AND COLITIS. - ISSN 1873-9946. - 8:12(2014 Dec 01), pp. 1684-1692.
|Titolo:||Accuracy and cost of diagnostic strategies for patients with suspected Crohn's disease|
|Parole Chiave:||Crohn's disease; diagnostic strategy; ileocolonoscopy; magnetic resonance imaging; ultrasound; video capsule endoscopy; gastroenterology|
|Settore Scientifico Disciplinare:||Settore MED/12 - Gastroenterologia|
|Data di pubblicazione:||1-dic-2014|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.crohns.2014.08.005|
|Appare nelle tipologie:||01 - Articolo su periodico|