Economic Benefit of Using a Pocket-Sized Ultrasound Device for the Initial Diagnostic Test in Symptomatic Patients with Suspected Gallstone Disease

Abstract

Purpose: To develop a model to evaluate the economic impact of a pocketsized ultrasound (PSU) device vs. the current standard of care as the initial diagnostic test for symptomatic gallstone patients. Methods: The study population included symptomatic patients with suspected gallstones presenting for initial evaluation to the healthcare system for which ultrasound would be the recommended diagnostic test. Two diagnostic testing strategies were compared: testing with and without use of the PSU. The model was developed from both a private payer (patients aged <65 years) and Medicare perspective (patients ≥65 years). Model inputs such as the number of symptomatic gallstone patients in the United States (US) and proportion < and ≥65 years of age were derived from literature. Medical claims data (data source: IMS LifeLink Health Plans Database) were utilized to identify patients newly diagnosed with gallstone disease (ICD-9 code: 574.xx) to obtain the prevalence of 8 diagnostic tests. The model assumed that time and cost of the initial office visit were equal between the two strategies. Additionally, a 30% and 16% rate of failed visualization was assumed to occur with the PSU and standard abdominal ultrasound, respectively, for which costs of a second diagnostic test would be incurred. Costs of diagnostic tests were obtained from the 2010 Medicare Physician Fee Schedule and claims data. Model outputs were summarized as costs saved per symptomatic patient in 2010 USD. Results: A total of 1.7 million symptomatic gallstone patients in the U.S. were included in the study population (59% <65 years, 41% >65 years). More than two-thirds (67.5%) of the gallstone patients identified in the claims data (N=20, 467) had a standard abdominal ultrasound as the initial diagnostic test. However, this proportion differed for patients <65 and ≥65 years of age (71.9% and 52.0%, respectively). Computed tomography was the next most common diagnostic test (21.5% of patients <65 years and 42.8% of patients >65 years of age). Based on the patterns of use of initial diagnostic tests, the model estimated that use of the PSU will potentially reduce costs by $141 (<65 years) and $165 (>65 years) per symptomatic patient. Conclusion: Use of the PSU for initial evaluation of symptomatic gallstone patients in an office-based setting will potentially result in cost savings to the U.S. healthcare system of 261 million USD. This research was supported by an industry grant from GE Healthcare.