Is Repeat Computed Tomography Angiography for Asymptomatic Grade 1 Blunt Cerebrovascular Injuries Cost-Effective?

Area of Science:

• Vascular Surgery
• Radiology
• Health Economics

Background:

• Blunt cerebrovascular injuries (BCVI) typically require follow-up imaging to monitor for progression.
• Current guidelines recommend repeat computed tomography angiography (CTA) 7-10 days post-injury for BCVI evaluation.
• The cost-effectiveness of repeat CTA for low-grade BCVI remains a subject of investigation.

Purpose of the Study:

• To evaluate the cost-effectiveness of repeat computed tomography angiography (CTA) in patients with asymptomatic grade 1 blunt cerebrovascular injury (BCVI).
• To determine if the benefits of repeat CTA in detecting BCVI progression outweigh the costs.
• To inform clinical management strategies for asymptomatic grade 1 BCVI.

Main Methods:

• A decision-analytic model was constructed to assess the cost-effectiveness of repeat CTA versus no repeat CTA.
• The model focused on a hypothetical 50-year-old blunt trauma patient with asymptomatic grade 1 BCVI on antithrombotic therapy.
• Data on costs, probabilities, and quality-adjusted life years (QALYs) were derived from published literature, with deterministic analyses performed.

Main Results:

• The decision-analytic model indicated that repeating CTA is the optimal strategy for asymptomatic grade 1 BCVI.
• While incurring a slightly higher cost (net cost of $694.20), repeat CTA significantly improved effectiveness, yielding 0.94 QALYs compared to 0.86 QALYs without repeat CTA.
• Sensitivity analyses identified CTA cost, utility of unnecessary antithrombotic treatment, antithrombotic therapy cost, and stroke risk reduction from intervention as key influential variables.

Conclusions:

• Repeating computed tomography angiography (CTA) for asymptomatic grade 1 blunt cerebrovascular injury (BCVI) is a cost-effective management strategy.
• The substantial improvement in quality-adjusted life years (QALYs) justifies the incremental cost associated with follow-up CTA.
• This finding supports the routine use of repeat CTA in managing asymptomatic grade 1 BCVI to optimize patient outcomes.