CT angiography is cost-effective for confirmation of internal carotid artery occlusions

• Published in: Journal of neuroimaging Vol. 18; no. 4; p. 355
• Main Authors: Brown, Devin L, Hoffman, Stuart N, Jacobs, Teresa L, Gruis, Kirsten L, Johnson, Susan L, Chernew, Michael E
• Format: Journal Article
• Language: English
• Published: United States 01.10.2008
• Subjects: Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - surgery; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - economics; Carotid Stenosis - mortality; Carotid Stenosis - surgery; Catheterization, Peripheral - economics; Cerebral Angiography - economics; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - economics; Cerebral Infarction - mortality; Cost-Benefit Analysis; Decision Support Techniques; Endarterectomy, Carotid; Hospital Mortality; Hospitalization - economics; Humans; Markov Chains; Risk; Sensitivity and Specificity; Tomography, X-Ray Computed - economics
• ISSN: 1552-6569
• DOI: 10.1111/j.1552-6569.2007.00216.x

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. 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. 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. After screening examination has suggested an ICA occlusion, confirmatory testing with CTA provides similar effectiveness to catheter angiography and is less costly.