SHOULD ERCP BE ROUTINE AFTER AN EPISODE OF IDIOPATHIC PANCREATITIS - A COST-UTILITY ANALYSIS

Background: Patients often recover from an episode of acute pancreatit is with conservative therapy and without an identified cause. The opti ons include proceeding with ERCP to identify and treat an occult commo n bile duct stone or performing the procedure only after a second epis ode of idiopathic pancreatitis occurs. Methods: Decision analysis (SML TREE software) was used to determine incremental cost-utility. Variabl es were estimated from a search of the literature, a utility analysis involving health professionals familiar with the question, and a retro spective review of hospital charts and costs, Results: This model esti mates an incremental utility gain for the prompt ERCP approach of 1.0 quality-adjusted life weeks per patient at an incremental cost of $245 (Canadian). This yields a cost-utility ratio of $12,740 (Canadian) pe r quality-adjusted life year. The result was highly sensitive to the p robability of finding an occult common bile duct stone. Conclusion: Ro utine ERCP is of marginal overall benefit, but is of more substantial benefit and is more cost-effective in a subgroup of patients with a gr eater probability of having an occult common duct stone.