Article-MRCP cost-effective for Klatskin stenting

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31 May 2002

MRCP cost-effective for Klatskin stenting

Am J Gastroenterol 2002; 97: 1152-1158

The use of magnetic resonance cholangiopancreatography (MRCP) to guide biliary stent placement in patients with inoperable hilar obstruction is a cost-effective treatment, researchers from the Mayo Clinic, Rochester, have found. Patients with cholangiocarcinoma at the hepatic bifurcation, known as Klatskin tumors, affecting both the left and right duct, are usually treated palliatively with a bilateral biliary stent replacement. However, MRCP visualization of the hepatic ducts allows a noninvasive means of determining communicating and dissociated bile duct regions, and thus their suitability for stent insertion. Investigating the cost efficiency of MRCP, Todd Baron and G Harewood implemented a decision analysis model to assess approaches for palliative treatment for jaundiced patients with inoperable, malignant hilar obstruction. In particular, baseline probabilities taken from published studies were used to calculate the Medicare reimbursement costs according to 2001 fees, for the two management strategies. Importantly, Baron and Harewood reveal the use of preprocedure MRCP to guide stent placement to be the most economical strategy at a cost of $3806, compared with a bilateral stent placement ($4275), provided the biliary stent complication rate was >3%. Indeed, for bilateral stent placement to be more cost-effective, a survival advantage of at least seven days over unilateral stent was required. Writing in the American Journal of Gastroenterology, the authors conclude: 'The uncertainty of any survival advantage that bilateral biliary stent placement confers over unilateral stent placement makes cost-effectiveness difficult to assess.'

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