Quantitative MRCP as Part of Primary Sclerosing Cholangitis Standard of Care in the National Health Service in England: A Feasibility Assessment Among Hepatologists

TL;DR

This study assesses the feasibility of using quantitative MRCP to improve the management of primary sclerosing cholangitis in the NHS.

Contribution

The study introduces the feasibility and perceived usefulness of quantitative MRCP (MRCP+) in PSC patient management within the NHS.

Findings

MRCP+ was perceived as more useful than liver biopsy and ERCP for PSC management.

A price point of up to GBP 500 was unlikely to hinder adoption of MRCP+.

MRCP+ has potential to reduce subjectivity and objectively measure biliary disease progression.

Abstract

Background: Primary sclerosing cholangitis (PSC) is a rare chronic liver disease characterised by bile duct strictures. Magnetic resonance cholangiopancreatography (MRCP) is the principal imaging modality for diagnosis; however, its interpretation is subjective. Quantitative MRCP (MRCP+) provides quantitative assessment of the biliary anatomy and can support objective disease assessment. We evaluated the potential impact, feasibility, and perceived usefulness that MRCP+ would have on PSC patient management. Methods: Alongside systematic evaluation of UK and European clinical guidelines on PSC management, semi-structured interviews with 16 stakeholders were conducted. The Lean Assessment Process methodology was used to assess potential impact and feasibility of adopting MRCP+ for the PSC care pathway within the NHS. Price as a barrier to adoption was investigated to evaluate perceptions between technology cost and adoption. Perceived ease of use and perceived trust were calculated and used to evaluate perceived usefulness (PU). Results: For PSC management, MRCP (81%) scored higher than liver biopsy (68%) and ERCP (50%) due to its non-invasive nature. There was good internal consistency between responders on the relationship between price point and the use of MRCP+ to support diagnosis (CA:0.836) and monitoring (CA:0.904). A price point of up to GBP 500 was unlikely to be a barrier for adoption. The overall perceived usefulness for MRCP+ for patient management was 74%. Conclusions: There is strong interest in using MRCP+ to support PSC management. MRCP+ has the potential to address unmet needs including reducing subjectivity, measurement of the whole biliary tree and objectively measuring biliary disease progression.

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