Different Imaging Strategies in Patients With Possible Basilar Artery Occlusion: Cost-Effectiveness Analysis

Area of Science:

• Medical Imaging
• Health Economics
• Neurology

Background:

• Basilar artery occlusion is a critical condition requiring timely diagnosis.
• Noninvasive imaging strategies are crucial for patient management.
• Evaluating the cost-effectiveness of these strategies is essential for healthcare resource allocation.

Purpose of the Study:

• To assess the cost-effectiveness of various noninvasive imaging strategies for detecting basilar artery occlusion.
• To compare computed tomographic angiography (CTA), magnetic resonance imaging (MRI), nonenhanced CT, and duplex ultrasound.
• To identify the optimal imaging strategy based on long-term outcomes and economic value.

Main Methods:

• A Markov decision analytic model was employed for long-term outcome evaluation.
• The analysis adopted a societal perspective with US cost data.
• Quality-adjusted life-years (QALYs) and net monetary benefits were key outcome measures, with a willingness-to-pay threshold of $80,000/QALY.

Main Results:

• Computed tomographic angiography (CTA) dominated all other strategies, yielding higher QALYs and net monetary benefits.
• CTA demonstrated a 96% probability of being cost-effective at the $80,000/QALY threshold.
• Duplex ultrasound was cost-effective only under specific low pre-test probability conditions; MRI and nonenhanced CT were not optimal.

Conclusions:

• Computed tomographic angiography (CTA) is the recommended cost-effective imaging strategy for patients with suspected basilar artery occlusion.
• CTA provides superior value compared to MRI, nonenhanced CT, and duplex ultrasound in this clinical context.