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Cost-effectiveness targets for multi-detector row CT angiography in the work-up of patients with intermittent
Karen Visser1, Marc C J M Kock, Karen M Kuntz
1Program for the Assessment of Radiological Technology, Department of Epidemiology and Biostatistics, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 50, Rm Ee21-40B, 3015GE Rotterdam, The Netherlands. k.visser@erasmusmc.nl
Insights
Multi-detector row CT angiography is a cost-effective imaging option for intermittent claudication. It offers high sensitivity for detecting significant stenoses, making it a valuable tool compared to MR angiography.
Area of Science:
- Vascular Imaging
- Health Economics
- Medical Decision Making
Background:
- Intermittent claudication significantly impacts patient quality of life.
- Accurate imaging is crucial for guiding treatment decisions in peripheral artery disease.
- Gadolinium-enhanced MR angiography is a current standard for vascular assessment.
Purpose of the Study:
- To evaluate the cost-effectiveness of multi-detector row CT angiography (MDCT-CTA) versus MR angiography (MRA) for intermittent claudication.
- To determine the cost, sensitivity, and equivocal result rate thresholds for MDCT-CTA to be cost-effective.
- To compare the societal cost-effectiveness based on quality-adjusted life years (QALYs) and lifetime costs.
Main Methods:
- A decision model was employed to compare MDCT-CTA with gadolinium-enhanced MRA.
- Quality-adjusted life years (QALYs) and lifetime costs were the primary outcome measures.
- Threshold analysis was performed using an incremental cost-effectiveness threshold of $100,000 per QALY.
Main Results:
- MDCT-CTA is cost-effective at $300 cost and 85% sensitivity, even with 35% equivocal results if only angioplasty is considered.
- When both angioplasty and bypass surgery are treatment options, MDCT-CTA is cost-effective at $300 cost, >94% sensitivity, and 20% equivocal results.
- These findings highlight the economic viability of MDCT-CTA in specific clinical scenarios.
Conclusions:
- Multi-detector row CT angiography demonstrates potential cost-effectiveness in evaluating patients with intermittent claudication.
- MDCT-CTA may offer a more economical alternative to existing imaging modalities like MRA.
- Further research can validate these cost-effectiveness findings in clinical practice.
Purpose:
To determine the costs, sensitivity for detection of significant stenoses, and proportion of equivocal multi-detector row computed tomographic (CT) angiography results in the work-up of patients with intermittent claudication that would make this imaging examination cost-effective compared with gadolinium-enhanced magnetic resonance (MR) angiography.
Materials And Methods:
A decision model was used to compare the societal cost-effectiveness of a new imaging modality with that of gadolinium-enhanced MR angiography. Main outcome measures were quality-adjusted life years (QALYs) and lifetime costs. By using threshold analysis of a given willingness to pay per QALY, target values for costs, sensitivity for detection of significant stenoses, and proportion of cases requiring additional work-up with intraarterial digital subtraction angiography owing to equivocal results of the new modality were determined. The base case evaluated was that of 60-year-old men with severe intermittent claudication and assumed an incremental cost-effectiveness threshold of 100,000 US dollars per QALY.
Results:
If treatment were limited to angioplasty, a new imaging modality would be cost-effective if the costs were 300 US dollars and the sensitivity was 85%, even if up to 35% of patients needed additional work-up. When both angioplasty and bypass surgery were considered as treatment options, a new imaging modality was cost-effective if the costs were 300 US dollars, the sensitivity was higher than 94%, and 20% of patients required additional work-up.
Conclusion:
Multi-detector row CT angiography, as compared with currently used imaging modalities such as MR angiography, has the potential to be cost-effective in the evaluation of patients with intermittent claudication.