Cost-effectiveness of Follow-up CT for Incidental Ascending Aortic Dilatation
Mark M Hammer1, Chung Yin Kong1
1Department of Radiology (Thoracic Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); and Icahn School of Medicine at Mount Sinai, New York, NY (C.Y.K.).
Insights
The most cost-effective strategy for incidental aortic dilatation is follow-up CT for patients under 60 with aortas ≥40mm every 3 years. Follow-up CT for aortas <50mm is not cost-effective in older patients.
Area of Science:
- Radiology and Imaging
- Cardiovascular Medicine
- Health Economics
Background:
- Incidental findings of aortic dilatation on CT scans require management strategies.
- Determining the optimal follow-up protocol is crucial for patient outcomes and resource allocation.
- Cost-effectiveness analysis can guide clinical decision-making for managing incidental aortic dilatation.
Purpose of the Study:
- To evaluate the cost-effectiveness of various computed tomography (CT) follow-up strategies for incidentally detected aortic dilatation.
- To identify the most economically viable approach for monitoring patients with dilated aortas.
Main Methods:
- A simulation model was developed using 1,000,000 adult patients aged 55-75 with incidentally detected aortic dilatation (40-50 mm).
- Various follow-up CT strategies were assessed based on patient age and aortic size, with follow-up frequencies from 1 to 3 years.
- Costs and quality-adjusted life-years (QALYs) were calculated, and a probabilistic sensitivity analysis was performed.
Main Results:
- The most cost-effective strategy identified was follow-up CT every 3 years for patients younger than 60 with aortas measuring at least 40 mm (ICER: $62,511 per QALY).
- This strategy required follow-up imaging for only 17% of dilated aortas in the cohort.
- Other cost-effective strategies included no follow-up for aortas <50 mm and tailored 3-year follow-ups for specific age and size subgroups.
Conclusions:
- Follow-up CT for incidentally detected ascending aortic dilatation smaller than 50 mm is generally not cost-effective in patients aged 60-65 years and older.
- The findings support age- and size-specific CT follow-up protocols to optimize cost-effectiveness in managing incidental aortic dilatation.
Purpose:
To evaluate the cost-effectiveness of CT follow-up strategies for incidental aortic dilatation.
Materials And Methods:
In this cost-effectiveness analysis, a simulation model was developed with 1 000 000 adult patients aged 55-75 years with incidentally detected dilated aortas measuring 40-50 mm. Follow-up CT strategies were evaluated for various patient age- and aortic size-based cutoffs. Follow-up frequency ranged from 1 to 3 years, as well as a single follow-up CT examination at 1 year. Patient survival was determined by risk of aortic dissection or rupture and surgical- and age-based mortality. Costs and quality-adjusted life-years (QALYs) were calculated for each strategy within the simulated cohort. A probabilistic sensitivity analysis was performed by varying model parameters.
Results:
The cost-effective strategy with the highest QALYs under a willingness-to-pay threshold of $100 000 per QALY was follow-up CT for patients younger than 60 years with aortas measuring at least 40 mm in diameter every 3 years (incremental cost-effectiveness ratio, $62 511; 95% CI: $52 168, $77 739). With this strategy, follow-up imaging was needed for only 17% of dilated aortas in the cohort. Probabilistic sensitivity analysis demonstrated that the cost-effective strategies at $100 000 per QALY threshold included the following: no follow-up for patients with aortas smaller than 50 mm (39% of simulations), follow-up every 3 years for patients younger than 55 years with aortas measuring at least 45 mm (21%), and follow-up every 3 years for patients older than 65 years with aortas measuring at least 40 mm (14%).
Conclusion:
Follow-up CT for an incidentally detected dilated ascending aorta smaller than 50 mm is likely not cost-effective in patients older than 60-65 years.Keywords: CT, Thorax, Vascular, Aorta, Cost-Effectiveness, Cost-Benefit Analysis Supplemental material is available for this article. © RSNA, 2023See also commentary by Shen and Fleischmann in this issue.
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