| CT angiography is cost-effective for confirmation of internal carotid artery occlusions. | |
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MedLine Citation:
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PMID: 18321251 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: While sensitive to internal carotid artery (ICA) occlusion, carotid ultrasound can produce false-positive results. CT angiography (CTA) has a high specificity for ICA occlusion and is safer and cheaper than catheter angiography, although less accurate. We determined the cost-effectiveness of CTA versus catheter angiography for confirming an ICA occlusion first suggested by carotid ultrasound. METHODS: A Markov decision-analytic model was constructed to estimate the cost-effectiveness of CTA compared with catheter angiography in a hypothetical cohort of symptomatic patients with a screening examination consistent with an ICA occlusion. Costs in 2004 dollars were estimated from Medicare reimbursement. Effectiveness was measured in quality-adjusted life years. RESULTS: The 2-year cost in the CTA scenario was $9,178, and for catheter angiography, $11,531, consistent with a $2,353 cost-savings per person for CTA. CTA resulted in accrual of 1.83 quality-adjusted life years while catheter angiography resulted in 1.82 quality-adjusted life years. CTA was less costly and marginally more effective than catheter angiography. In sensitivity analyses, when CTA sensitivity and specificity were allowed to vary across a plausible range, CTA remained cost-effective. CONCLUSIONS: After screening examination has suggested an ICA occlusion, confirmatory testing with CTA provides similar effectiveness to catheter angiography and is less costly. |
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Authors:
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Devin L Brown; Stuart N Hoffman; Teresa L Jacobs; Kirsten L Gruis; Susan L Johnson; Michael E Chernew |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural Date: 2008-01-07 |
Journal Detail:
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Title: Journal of neuroimaging : official journal of the American Society of Neuroimaging Volume: 18 ISSN: 1552-6569 ISO Abbreviation: J Neuroimaging Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-11-17 Completed Date: 2009-03-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9102705 Medline TA: J Neuroimaging Country: United States |
Other Details:
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Languages: eng Pagination: 355-9 Citation Subset: IM |
Affiliation:
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Stroke Program, University of Michigan, Ann Arbor, MI 48109-5855, USA. devinb@umich.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Carotid Artery, Internal
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radiography*,
surgery Carotid Stenosis / economics*, mortality, radiography, surgery Catheterization, Peripheral / economics* Cerebral Angiography / economics* Cerebral Infarction / economics, mortality, radiography Cost-Benefit Analysis Decision Support Techniques Endarterectomy, Carotid Hospital Mortality Hospitalization / economics Humans Markov Chains Risk Sensitivity and Specificity Tomography, X-Ray Computed / economics* |
| Grant Support | |
ID/Acronym/Agency:
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K23 NS051202/NS/NINDS NIH HHS; K23 NS055200/NS/NINDS NIH HHS |
| Comments/Corrections | |
Comment In:
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J Neuroimaging. 2008 Oct;18(4):353-4
[PMID:
19012735
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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