In:
Annals of Neurology, Wiley, Vol. 58, No. 4 ( 2005-10), p. 506-515
Kurzfassung:
The main objective of this study was to assess the long‐term cost‐effectiveness of five alternative diagnostic strategies for identification of severe carotid stenosis in recently symptomatic patients. A decision‐analytical model with Markov transition states was constructed. Data sources included a prospective study involving 167 patients who had screening Doppler ultrasound (DUS), confirmatory contrast‐enhanced magnetic resonance angiography (CEMRA) and confirmatory digital subtraction angiography (DSA), individual patient data from the European Carotid Surgery Trial and other published clinical and cost data. A “selective” strategy, whereby all patients receive DUS and CEMRA (only proceeding to DSA if the CEMRA is positive and the DUS is negative), was most cost‐effective. This was both the cheapest imaging and treatment strategy ($35,205 per patient) and yielded 6.1590 quality‐adjusted life years (QALYs), higher than three alternative imaging strategies. Probabilistic sensitivity analysis demonstrated that there was less than a 10% probability that imaging with either DUS or DSA alone are cost‐effective at the conventional $50,000/QALY threshold. In conclusion, DSA is not cost‐effective in the routine diagnostic workup of most patients. DUS, with additional imaging in the form of CEMRA, is recommended, with a strategy of “CEMRA and selective DUS review” being shown to be the optimal imaging strategy. Ann Neurol 2005;58:506–515
Materialart:
Online-Ressource
ISSN:
0364-5134
,
1531-8249
Sprache:
Englisch
Verlag:
Wiley
Publikationsdatum:
2005
ZDB Id:
2037912-2
