Jana Ivanidze MD, PhD, Presenter: Nothing to Disclose

Resmi Charalel MD, Abstract Co-Author: Nothing to Disclose

Omar Nabil Kallas, Abstract Co-Author: Nothing to Disclose

Matthew Spector Simon MD, MSc, Abstract Co-Author: Nothing to Disclose

Ajay Gupta MD, Abstract Co-Author: Nothing to Disclose

Pina Christine Sanelli MD, Abstract Co-Author: Nothing to Disclose

Establishing the value of imaging through cost-effectiveness analyses has become a major focus in our changing healthcare environment. Despite concerns regarding the effects of radiation exposure from CT, there have been no cost-effectiveness analyses incorporating these risks. The purpose of this study was to determine the benefits and harms of radiation exposure from CT angiography and perfusion (CTAP) in aneurysmal subarachnoid hemorrhage (SAH).

We modified our previous decision model comparing CTAP and transcranial Doppler ultrasound (TCD) by incorporating the long-term risk of developing brain cancer from CTAP. The clinical pathways were developed according to published guidelines. The input probabilities were based on literature data as well as a cohort at our institution. Outcome health states reflect functional SAH outcomes, combined with the delayed outcome of developing brain cancer. Cancer risk was calculated using National Cancer Institute (NCI) methodology. Radiation doses for CTAP and latency of onset of brain cancer after radiation exposure were taken from published literature. Expected health benefits and costs were calculated for each imaging strategy. Univariable and multivariable sensitivity analyses were performed.

The CTAP strategy was dominant over the TCD strategy when incorporating brain cancer risk, calculated as 0.000274 (95% CI: 0.000053; 0.000802). Our results remained robust in a two-way sensitivity analysis when varying the brain cancer risk within the CI limits and the latency of cancer onset from 0.1 to 30 years. Even assuming higher risk (up to 50 times higher than calculated), the CTAP strategy (NEW strategy) remained dominant over the TCD strategy (STANDARD strategy) for the published brain cancer latency of 10 years (Figure 1).

While the development of brain cancer from radiation exposure in patients undergoing CTAP is an important consideration, it does not alter the fact that CTAP is the preferred imaging strategy compared to TCD, with overall improved clinical outcomes and lower healthcare costs. This is true even when modeling a significantly higher risk and shorter latency period than what is known from published literature.

While accounting for the risk of developing radiation-induced brain cancer, CTAP remains the superior imaging modality in SAH, resulting in improved clinical outcomes and lower healthcare costs.

Ivanidze, J, Charalel, R, Kallas, O, Simon, M, Gupta, A, Sanelli, P, Incorporating the Effects of Radiation Exposure from CT-Angiography and Perfusion in Cost-Effectiveness Analyses in Subarachnoid Hemorrhage.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013437.html