Cost-Effectiveness Study of Initial Imaging Selection in Acute Ischemic Stroke Care

Area of Science:

• Neurology
• Radiology
• Health Economics

Background:

• National guidelines advocate for rapid identification of acute ischemic stroke (AIS) candidates for treatment.
• Timely neuroimaging using CT or MRI is crucial for AIS diagnosis and treatment.
• While MRI offers higher accuracy, its complex workflow can delay treatment, making CT often the preferred initial choice due to availability and speed.

Purpose of the Study:

• To analyze the impact of different initial imaging strategies on patient outcomes.
• To evaluate imaging utilization before treatment decisions in comprehensive stroke centers for anterior circulation AIS.
• To assess outcomes for patients with a last-known-well-to-arrival time of 0 to 24 hours.

Main Methods:

• A decision simulation model was developed based on American Heart Association AIS care pathways.
• Five initial imaging strategies were compared: stepwise-CT, stepwise-hybrid, stepwise-advanced, comprehensive-CT, and comprehensive-MR.
• Cost-effectiveness and sensitivity analyses were performed using evidence-based data.

Main Results:

• Comprehensive-CT and comprehensive-MR strategies yielded the highest quality-adjusted life-years (QALYs).
• Comprehensive-CT demonstrated superior cost-effectiveness compared to comprehensive-MR ($233,000/QALY).
• Stepwise imaging strategies (CT, hybrid, advanced) were found to be dominated, offering lower QALYs and higher costs than comprehensive-CT.

Conclusions:

• Comprehensive-CT at presentation is the most cost-effective initial imaging strategy for AIS patients.
• This strategy optimizes patient outcomes within comprehensive stroke centers.
• The findings support the integration of comprehensive-CT into standard AIS care pathways.