Endoscopy 2007; 39(3): 222-228
DOI: 10.1055/s-2007-966253
Original article
© Georg Thieme Verlag KG Stuttgart · New York

The roles of magnetic resonance and endoscopic retrograde cholangiopancreatography (MRCP and ERCP) in the diagnosis of patients with suspected sclerosing cholangitis: a cost-effectiveness analysis

S.  Meagher1 , I.  Yusoff2 , W.  Kennedy1 , M.  Martel1 , V.  Adam1, 3, 4 , A.  Barkun1, 3, 4
  • 1Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital Site, McGill University, Montreal, Québec, Canada
  • 2Division of Gastroenterology, New South Wales University, Perth, Australia
  • 3Division of Clinical Epidemiology, McGill University, Montreal, Québec, Canada
  • 4McGill University Health Centre, Montreal General Hospital Site, McGill University, Montreal, Québec, Canada
Further Information

Publication History

submitted 31 March 2006

accepted after revision 29 September 2006

Publication Date:
26 March 2007 (online)

Background and study aims: The optimal approach for diagnosing sclerosing cholangitis remains unclear in the face of competing imaging technologies. We aimed to determine the most cost-effective strategy.

Patients and methods: A decision model compared three approaches in the work-up of patients with suspected sclerosing cholangitis; all included an initial test, with, if unsuccessful, performance of a second cholangiographic method. They were magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP), termed ”MRCP_ERCP”, ERCP and MRCP (”ERCP_MRCP”), or ERCP and a repeat ERCP (”ERCP_ERCP”). The implications of true and false positive and negative results with regard to costs and procedural complications were considered, including that of a liver biopsy, if indicated as a result of a negative work-up in the face of persistent clinical suspicion. The unit of effectiveness adopted was that of a correct diagnosis. Probability assumptions were derived from published literature, while cost estimates were derived from time-motion microanalyses or a national database, and expressed in Canadian dollars at 2004 values. Sensitivity analyses, including clinically relevant threshold analyses, were carried out.

Results: The average cost-effectiveness ratios were $ 414 for MRCP_ERCP, $ 1101 for ERCP_MRCP and $ 1123 for ERCP_ERCP, per correct diagnosis. The ERCP_MRCP strategy was dominated (more expensive and less effective) by MRCP_ERCP, while ERCP_ERCP was more effective and more costly than MRCP_ERCP, at $ 289 292 per additional correct diagnosis. Sensitivity and threshold analyses confirmed the robustness of these findings.

Conclusions: Based on the model assumptions, a strategy of initial MRCP, followed, if negative, by ERCP is currently the most cost-effective approach to the work-up of patients with suspected sclerosing cholangitis.


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A. N. Barkun, MD 

Division of Gastroenterology

The McGill University Health Centre - the Montreal General Hospital Site

1650 Cedar Avenue


Québec, H3G 1A4


Email: alan.barkun@muhc.mcgill.ca