Cost-Effectiveness of Computed Tomographic Enterography Compared to Magnetic Resonance Enterography in a Simulated Medicare Population With Crohn's Disease

Abstract

Background: We estimated the cost-effectiveness of evaluating small-bowel Crohn's disease with magnetic resonance enterography (MRE) as an alternative to computed tomographic enterography (CTE) in Medicare-eligible patients. We assessed the potential cancer risk averted by using MRE. Methods: We developed a Markov model to compare the lifetime costs, benefits (measured in quality-adjusted life-years [QALYs] and cancers averted) and cost-effectiveness of using MRE rather than CTE for routine disease monitoring in a hypothetical cohort of 100,000 patients with Crohn's disease beginning at age 65. We assumed each CT-radiation exposure conferred an incremental annual risk of developing cancer using the linear, no-threshold model. We varied scan frequency, dose equivalent per scan, and risk of cancer per dose equivalent of exposure. Results: In the base case, using MRE instead of CTE every 5 years until age 85 has an incremental cost-effectiveness ratio (ICER) of $1,458,000/QALY. Two hundred ninety-five additional cancers in the simulated cohort were averted by using MRE alone. High-frequency scanning with two MRE scans per year up to age 85 resulted in an ICER of $1,112,000/QALY. In sensitivity analyses, only if the cost of MRE were less than $200 more than CTE, testing with MRE until age 70 would be costeffective, with an ICER of $75,000. Results were not sensitive to either patients' previous number of CTEs prior to age 65 or the effective dose (up to 24 mSv per CTE) per scan. Conclusions: MRE is not a cost-effective alternative to CTE among patients in this simulated population with Crohn's disease.