Access to intestinal ultrasound influences diagnostic decision-making, reduces healthcare costs and improves sustainability in inflammatory bowel disease

Introduction Growing evidence supports the diagnostic accuracy and utility of intestinal ultrasound (IUS) in inflammatory bowel disease (IBD). However, limited data exist on how access to IUS influences real-world diagnostic decision-making, healthcare costs and sustainability. This study evaluated whether access to IUS reduced magnetic resonance enterography (MRE) and colonoscopy use and estimated associated cost-savings and carbon emission reductions. Methods An analysis of a prospectively maintained IUS referral database at an Australian tertiary IBD centre was undertaken over 24 months. At the time of referral, clinicians indicated whether IUS was requested instead of, or in addition to, MRE and/or colonoscopy. ‘Instead of’ was predefined as no MRE or colonoscopy within 3 months before or 6 months after IUS. The primary outcome was investigation avoidance, with estimated cost-savings and carbon emission reductions designated secondary outcomes. Results Among 427 referrals (Crohn’s disease 70. 5%, ulcerative colitis 19. 2%, suspected IBD 10. 3%), IUS replaced 184 MREs and 130 colonoscopies over 24 months. This resulted in estimated cost savings of AUD 360 822 (USD 231 893), predominantly driven by colonoscopy avoidance, which was 2. 4-fold greater than MRE-related savings. Access to IUS was also associated with a reduction in carbon emissions of 11 907 kgCO₂e over 24 months, attributable to reduced MRE and colonoscopy utilisation. IUS most frequently replaced MRE in Crohn’s disease (65. 3%) and colonoscopy in ulcerative colitis (97. 7%), with Crohn’s disease yielding approximately threefold greater cost-savings and emission reductions than ulcerative colitis. Conclusion Integration of IUS into IBD care reduced the use of MRE and colonoscopy, delivering substantial cost-savings and carbon emission reductions. These findings support IUS as a cost-effective and sustainable disease monitoring strategy in IBD.