Hansel Javier Otero, Presenter: Nothing to Disclose

Michael Tse-Yin Lu BS, Abstract Co-Author: Nothing to Disclose

David S. Gerson, Abstract Co-Author: Nothing to Disclose

Frank John Rybicki MD, PhD, Abstract Co-Author: Speakers Bureau, Toshiba Corporation Advisory Board, Toshiba Corporation Speakers Bureau, Siemens AG Speakers Bureau, Bracco Group Advisory Board, Bracco Group Advisory Board, Vital Images, Inc

To determine the cost-effectiveness of CT right ventricle/left ventricle (RV/LV)4-chamber measurements (cutoff ratio=0.9)for risk stratification in pulmonary embolism (PE) patients.

A decision analysis model was used to determine incremental cost-effectiveness of universal CT measurements of RV compared with a baseline strategy using echocardiography (usual care) to predict RV dysfunction and hence the need for thrombolysis. Using a 90-day time horizon, with an all cause mortality of 15%, the cost per number of deaths predicted, number of “low risk” (no RV dysfunction) diagnosis, and quality-adjusted life years (QALY) were calculated. We used a healthcare payer perspective with all costs being marginal and adjusted from 2006 Medicare fee schedule. One-way Sensitivity analysis for all parameters was performed to assess the robustness of the results, a worse case scenario was also calculated. We used commercially available decision-analysis software (TreeAge Pro) to perform all computations.

The Echocardiography strategy resulted in CE ratios of $3,707 per predicted death and $814 per low-risk diagnosis. MDCT resulted in cost-savings of $3,537 and $754 per predicted death and low-risk diagnosis made, respectively. Adding therapy, the MDCT strategy generated incremental costs of $172.6 per patient, and cost-utility ratio of $2,685 per quality-adjusted life months (QALM) or $32,224 per QALY. Sensitivity analyses revealed the robustness of our intermediary effectiveness measures, while increasing ICER to $141,521 per QALM (~$1.7 million per QALY) under worse case scenario assumptions.

CT evaluation of the RV in patients with PE has significant financial benefits as utilization increases. These benefits will only be possible if new therapeutic approaches and more aggressive management are established. Additional research in the impact over patients’ outcomes that the information provided by CT scans are warranted, and supported from a cost-effectiveness perspective.

MDCT can yield information that would otherwise require echocardiography. Maximizing the CT data can reduce the national costs of managing PE patients by up to $53 million.

Otero, H, Lu, M, Gerson, D, Rybicki, F, Cost-effectiveness of Computed Tomography in the Evaluation of Right Heart Dysfunction in Patients with Acute Pulmonary Embolism.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5006011.html