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Pretreatment imaging workup for patients with intermittent claudication: a cost-effectiveness analysis
Karen Visser1, Karen M Kuntz, Magruder C Donaldson
1Program for the Assessment of Radiological Technology Program, Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center Rotterdam, The Netherlands. k.visser@epib.fgg.eur.nl
Journal of Vascular and Interventional Radiology : JVIR
|January 15, 2003
Summary
For intermittent claudication, magnetic resonance angiography (MRA) or duplex ultrasonography (US) can replace digital subtraction angiography (DSA) without significant loss in effectiveness. These noninvasive imaging strategies offer a slight cost reduction for patient workup.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Health Economics
Background:
- Intermittent claudication necessitates effective pretreatment imaging for optimal patient management.
- Digital subtraction angiography (DSA) has been a standard, but invasive, diagnostic tool.
- Noninvasive modalities like magnetic resonance angiography (MRA) and duplex ultrasonography (US) offer alternatives.
Purpose of the Study:
- To determine the optimal imaging strategy for intermittent claudication pretreatment workup.
- To compare the cost-effectiveness (CE) of MRA, US, and DSA.
- To evaluate imaging strategies based on sensitivity, complication rates, and treatment implications.
Main Methods:
- A decision-analytic model was developed to assess societal cost-effectiveness.
- Model incorporated test characteristics: sensitivity, complications, missed lesions, overtreatment consequences.
- Analysis focused on a cohort of 60-year-old males with severe intermittent claudication.
Main Results:
- Small differences in effectiveness (0.025 QALYs) and lifetime costs ($1,800) were observed across strategies.
- MRA showed an incremental CE ratio of $35,000/QALY vs. no workup; DSA was $471,000/QALY vs. MRA.
- When considering angioplasty and bypass surgery, DSA was more costly and less effective than MRA and US.
Conclusions:
- MRA and US can replace DSA for intermittent claudication imaging without substantial loss of effectiveness.
- Noninvasive imaging modalities offer a slight cost reduction compared to DSA.
- The choice of imaging strategy has minimal impact on overall patient outcomes and costs.