Sebastian Ekkehard Beyer, Presenter: Nothing to Disclose

Birgit Betina Ertl-Wagner MD, Abstract Co-Author: Nothing to Disclose

M.G. Myriam Hunink MD, PhD, Abstract Co-Author: Nothing to Disclose

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Wieland H. Sommer MD, Abstract Co-Author: Nothing to Disclose

To evaluate the cost-effectiveness of different non-invasive imaging strategies in patients with suspected basilar artery occlusion.

A Markov decision analytic model was used to evaluate long-term outcomes resulting from strategies employing non-enhanced CT, CT angiography, or magnetic resonance (MR) angiography. The analysis was performed from the societal perspective using USA recommendations for such analyses. Input parameters were derived from the literature. Costs were obtained from US costing sources and published literature. Outcomes were lifetime costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net monetary benefits (NMB), with willingness-to-pay (WTP) thresholds of $50,000 and $80,000 per QALY. The strategy with the highest net monetary benefit was considered the most cost effective. Extensive deterministic and probabilistic sensitivity analyses were performed to explore the effect of varying parameter values.

In the reference case analysis, both CTA and MRI resulted in a similar increase in QALYs (0.31 and 0.33, respectively) compared to non-enhanced CT. MRI yielded 0.02 QALYs more than CTA at a cost of $44,668 per QALY gained. At WTP thresholds of $50,000 and $80,000 per QALY, MRI yielded the highest NMB. The probability that MRI is cost-effective was 51% at a WTP threshold of $50,000/QALY and 63% at $80,000/QALY (figure).

Our results suggest that MRI in patients with suspected basilar artery occlusion is cost-effective in the American setting.

In diagnosing basilar artery occlusion, MRI should be the initial test.

Beyer, S, Ertl-Wagner, B, Hunink, M, Reiser, M, Sommer, W, Different Imaging Strategies in Patients with Suspected Basilar Artery Occlusion: A Cost-effectiveness Analysis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015535.html