P C Sanelli1, A Pandya2, A Z Segal3, A Gupta4, S Hurtado-Rua2, J Ivanidze4, K Kesavabhotla4, D Mir4, A I Mushlin2, M G M Hunink5. 1. From the Departments of Radiology (P.C.S., A.G., J.I., K.K., D.M.) Public Health (P.C.S., A.P., S.H.-R., A.I.M.) pcs9001@med.cornell.edu. 2. Public Health (P.C.S., A.P., S.H.-R., A.I.M.). 3. Neurology (A.Z.S.), Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York. 4. From the Departments of Radiology (P.C.S., A.G., J.I., K.K., D.M.). 5. Departments of Radiology and Epidemiology (M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands.
Abstract
BACKGROUND AND PURPOSE: Delayed cerebral ischemia and vasospasm are significant complications following SAH leading to cerebral infarction, functional disability, and death. In recent years, CTA and CTP have been used to increase the detection of delayed cerebral ischemia and vasospasm. Our aim was to perform comparative-effectiveness and cost-effectiveness analyses evaluating CTA and CTP for delayed cerebral ischemia and vasospasm in aneurysmal SAH from a health care payer perspective. MATERIALS AND METHODS: We developed a decision model comparing CTA and CTP with transcranial Doppler sonography for detection of vasospasm and delayed cerebral ischemia in SAH. The clinical pathways were based on the "Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association" (2012). Outcome health states represented mortality and morbidity according to functional outcomes. Input probabilities of symptoms and serial test results from CTA and CTP, transcranial Doppler ultrasound, and digital subtraction angiography were directly derived from an SAH cohort by using a multinomial logistic regression model. Expected benefits, measured as quality-adjusted life years, and costs, measured in 2012 US dollars, were calculated for each imaging strategy. Univariable, multivariable, and probabilistic sensitivity analyses were performed to determine the independent and combined effect of input parameter uncertainty. RESULTS: The transcranial Doppler ultrasound strategy yielded 13.62 quality-adjusted life years at a cost of $154,719. The CTA and CTP strategy generated 13.89 quality-adjusted life years at a cost of $147,097, resulting in a gain of 0.27 quality-adjusted life years and cost savings of $7622 over the transcranial Doppler ultrasound strategy. Univariable and multivariable sensitivity analyses indicated that results were robust to plausible input parameter uncertainty. Probabilistic sensitivity analysis results yielded 96.8% of iterations in the right lower quadrant, representing higher benefits and lower costs. CONCLUSIONS: Our model results suggest that CTA and CTP are the preferred imaging strategy in SAH, compared with transcranial Doppler ultrasound, leading to improved clinical outcomes and lower health care costs.
BACKGROUND AND PURPOSE:Delayed cerebral ischemia and vasospasm are significant complications following SAH leading to cerebral infarction, functional disability, and death. In recent years, CTA and CTP have been used to increase the detection of delayed cerebral ischemia and vasospasm. Our aim was to perform comparative-effectiveness and cost-effectiveness analyses evaluating CTA and CTP for delayed cerebral ischemia and vasospasm in aneurysmalSAH from a health care payer perspective. MATERIALS AND METHODS: We developed a decision model comparing CTA and CTP with transcranial Doppler sonography for detection of vasospasm and delayed cerebral ischemia in SAH. The clinical pathways were based on the "Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association" (2012). Outcome health states represented mortality and morbidity according to functional outcomes. Input probabilities of symptoms and serial test results from CTA and CTP, transcranial Doppler ultrasound, and digital subtraction angiography were directly derived from an SAH cohort by using a multinomial logistic regression model. Expected benefits, measured as quality-adjusted life years, and costs, measured in 2012 US dollars, were calculated for each imaging strategy. Univariable, multivariable, and probabilistic sensitivity analyses were performed to determine the independent and combined effect of input parameter uncertainty. RESULTS: The transcranial Doppler ultrasound strategy yielded 13.62 quality-adjusted life years at a cost of $154,719. The CTA and CTP strategy generated 13.89 quality-adjusted life years at a cost of $147,097, resulting in a gain of 0.27 quality-adjusted life years and cost savings of $7622 over the transcranial Doppler ultrasound strategy. Univariable and multivariable sensitivity analyses indicated that results were robust to plausible input parameter uncertainty. Probabilistic sensitivity analysis results yielded 96.8% of iterations in the right lower quadrant, representing higher benefits and lower costs. CONCLUSIONS: Our model results suggest that CTA and CTP are the preferred imaging strategy in SAH, compared with transcranial Doppler ultrasound, leading to improved clinical outcomes and lower health care costs.
Authors: Mellanie V Springer; J Michael Schmidt; Katja E Wartenberg; Jennifer A Frontera; Neeraj Badjatia; Stephan A Mayer Journal: Neurosurgery Date: 2009-12 Impact factor: 4.654
Authors: Emmanuel Carrera; J Michael Schmidt; Mauro Oddo; Luis Fernandez; Jan Claassen; David Seder; Kiwon Lee; Neeraj Badjatia; E Sander Connolly; Stephan A Mayer Journal: Neurosurgery Date: 2009-08 Impact factor: 4.654
Authors: Jan Willem Dankbaar; Nicolien K de Rooij; Birgitta K Velthuis; Catharina J M Frijns; Gabriel J E Rinkel; Irene C van der Schaaf Journal: Stroke Date: 2009-09-17 Impact factor: 7.914
Authors: Tessa S S Genders; W Bob Meijboom; Matthijs F L Meijs; Joanne D Schuijf; Nico R Mollet; Annick C Weustink; Francesca Pugliese; Jeroen J Bax; Maarten J Cramer; Gabriel P Krestin; Pim J de Feyter; M G Myriam Hunink Journal: Radiology Date: 2009-10-28 Impact factor: 11.105
Authors: J Michael Schmidt; Katja E Wartenberg; Andres Fernandez; Jan Claassen; Fred Rincon; Noeleen D Ostapkovich; Neeraj Badjatia; Augusto Parra; E Sander Connolly; Stephan A Mayer Journal: J Neurosurg Date: 2008-12 Impact factor: 5.115
Authors: S V Eden; W J Meurer; B N Sánchez; L D Lisabeth; M A Smith; D L Brown; L B Morgenstern Journal: Neurology Date: 2008-06-11 Impact factor: 9.910
Authors: Andrew J Molyneux; Richard S C Kerr; Jacqueline Birks; Najib Ramzi; Julia Yarnold; Mary Sneade; Joan Rischmiller Journal: Lancet Neurol Date: 2009-03-28 Impact factor: 44.182
Authors: J Ivanidze; R A Charalel; I Shuryak; D Brenner; A Pandya; O N Kallas; K Kesavabhotla; A Z Segal; M S Simon; P C Sanelli Journal: AJNR Am J Neuroradiol Date: 2017-01-12 Impact factor: 3.825
Authors: Aric F Logsdon; Brandon P Lucke-Wold; Ryan C Turner; Jason D Huber; Charles L Rosen; James W Simpkins Journal: Compr Physiol Date: 2015-07-01 Impact factor: 9.090
Authors: Amr Abdulazim; Carla Küppers; Katharina A M Hackenberg; Eva Neumaier-Probst; Mohamad Mansour Alzghloul; Jörg Krebs; Manfred Thiel; Hester Lingsma; Gabriel J E Rinkel; Christoph Groden; Nima Etminan Journal: Acta Neurochir (Wien) Date: 2022-08-25 Impact factor: 2.816
Authors: Eric J Arias; Sravya Vajapey; Matthew R Reynolds; Michael R Chicoine; Keith M Rich; Ralph G Dacey; Ian G Dorward; Colin P Derdeyn; Christopher J Moran; DeWitte T Cross; Gregory J Zipfel; Rajat Dhar Journal: Stroke Date: 2015-09-24 Impact factor: 7.914
Authors: Adam de Havenon; Kole Mickolio; Steven O'Donnell; Greg Stoddard; J Scott McNally; Matthew Alexander; Philipp Taussky; Al-Wala Awad Journal: J Neurosurg Date: 2021-02-26 Impact factor: 5.408