Document Detail

CT angiography is cost-effective for confirmation of internal carotid artery occlusions.
MedLine Citation:
PMID:  18321251     Owner:  NLM     Status:  MEDLINE    
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.
Devin L Brown; Stuart N Hoffman; Teresa L Jacobs; Kirsten L Gruis; Susan L Johnson; Michael E Chernew
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2008-01-07
Journal Detail:
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:
Created Date:  2008-11-17     Completed Date:  2009-03-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102705     Medline TA:  J Neuroimaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  355-9     Citation Subset:  IM    
Stroke Program, University of Michigan, Ann Arbor, MI 48109-5855, USA.
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MeSH Terms
Carotid Artery, Internal / 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
Markov Chains
Sensitivity and Specificity
Tomography, X-Ray Computed / economics*
Grant Support
Comment In:
J Neuroimaging. 2008 Oct;18(4):353-4   [PMID:  19012735 ]

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