Ajay Gupta1, Alvin I Mushlin1, Hooman Kamel1, Babak B Navi1, Ankur Pandya1. 1. From the Departments of Radiology (A.G.), Neurology (H.K., B.B.N.), and Healthcare Policy and Research (A.I.M., A.P.), Weill Cornell Medical College, 1300 York Ave, New York, NY 10065.
Abstract
PURPOSE: To evaluate the cost-effectiveness of a decision-making rule based on the magnetic resonance (MR) imaging assessment of intraplaque hemorrhage (IPH) in patients with asymptomatic carotid artery stenosis. MATERIALS AND METHODS: Two competing stroke prevention strategies were compared: (a) an intensive medical therapy-based management strategy versus (b) an imaging-based strategy in which the subset of patients with asymptomatic carotid artery stenosis with IPH on MR images would undergo immediate carotid endarterectomy in addition to ongoing intensive medical therapy. Patients in the medical therapy-only group could undergo carotid endarterectomy only with substantial carotid artery stenosis disease progression. Lifetime quality-adjusted life years (QALYs) and costs were modeled for patients with asymptomatic carotid artery stenosis with 70%-89% and 50%-69% carotid artery stenosis at presentation. Risks of stroke and complications from carotid endarterectomy, costs, and quality of life values were estimated from published sources. RESULTS: The medical therapy-based strategy had a lower life expectancy (12.65 years vs 12.95 years), lower lifetime QALYs (9.96 years vs 10.05 years), and lower lifetime costs ($13 699 vs $15 297) when compared with the MR imaging IPH-based strategy. The incremental cost-effectiveness ratio (ICER) for the MR imaging IPH strategy compared with the medical therapy-based strategy was $16 000 per QALY by using a base-case 70-year-old patient. When using starting patient ages of 60 and 80 years, the ICERs for the MR imaging IPH strategy were $3100 per QALY and $73 000 per QALY, respectively. The ICERs for the MR imaging IPH strategy were slightly higher at all ages for 50%-69% stenosis but remained below a willingness-to-pay threshold of $100 000 per QALY for starting ages of 60 and 70 years. CONCLUSION: MR imaging IPH can be used as a cost-effective tool to identify patients with asymptomatic carotid artery stenosis most likely to benefit from carotid endarterectomy.
PURPOSE: To evaluate the cost-effectiveness of a decision-making rule based on the magnetic resonance (MR) imaging assessment of intraplaque hemorrhage (IPH) in patients with asymptomatic carotid artery stenosis. MATERIALS AND METHODS: Two competing stroke prevention strategies were compared: (a) an intensive medical therapy-based management strategy versus (b) an imaging-based strategy in which the subset of patients with asymptomatic carotid artery stenosis with IPH on MR images would undergo immediate carotid endarterectomy in addition to ongoing intensive medical therapy. Patients in the medical therapy-only group could undergo carotid endarterectomy only with substantial carotid artery stenosis disease progression. Lifetime quality-adjusted life years (QALYs) and costs were modeled for patients with asymptomatic carotid artery stenosis with 70%-89% and 50%-69% carotid artery stenosis at presentation. Risks of stroke and complications from carotid endarterectomy, costs, and quality of life values were estimated from published sources. RESULTS: The medical therapy-based strategy had a lower life expectancy (12.65 years vs 12.95 years), lower lifetime QALYs (9.96 years vs 10.05 years), and lower lifetime costs ($13 699 vs $15 297) when compared with the MR imaging IPH-based strategy. The incremental cost-effectiveness ratio (ICER) for the MR imaging IPH strategy compared with the medical therapy-based strategy was $16 000 per QALY by using a base-case 70-year-old patient. When using starting patient ages of 60 and 80 years, the ICERs for the MR imaging IPH strategy were $3100 per QALY and $73 000 per QALY, respectively. The ICERs for the MR imaging IPH strategy were slightly higher at all ages for 50%-69% stenosis but remained below a willingness-to-pay threshold of $100 000 per QALY for starting ages of 60 and 70 years. CONCLUSION: MR imaging IPH can be used as a cost-effective tool to identify patients with asymptomatic carotid artery stenosis most likely to benefit from carotid endarterectomy.
Authors: Chun Yuan; Shao-xiong Zhang; Nayak L Polissar; Denise Echelard; Geraldo Ortiz; Joseph W Davis; Elizabeth Ellington; Marina S Ferguson; Thomas S Hatsukami Journal: Circulation Date: 2002-01-15 Impact factor: 29.690
Authors: H J M Barnett; D W Taylor; R B Haynes; D L Sackett; S J Peerless; G G Ferguson; A J Fox; R N Rankin; V C Hachinski; D O Wiebers; M Eliasziw Journal: N Engl J Med Date: 1991-08-15 Impact factor: 91.245
Authors: Sashi Kilaru; Peter Korn; Karthikeshwar Kasirajan; Thomas Y Lee; Frederick P Beavers; Ross T Lyon; Harry L Bush; K Craig Kent Journal: J Vasc Surg Date: 2003-02 Impact factor: 4.268
Authors: Hongge Shu; Jie Sun; Thomas S Hatsukami; Niranjan Balu; Daniel S Hippe; Haining Liu; Ted R Kohler; Wenzhen Zhu; Chun Yuan Journal: J Magn Reson Imaging Date: 2017-02-06 Impact factor: 4.813
Authors: John C Benson; Heidi Cheek; Marie C Aubry; Giuseppe Lanzino; John Huston Iii; Alejandro Rabinstein; Waleed Brinjikji Journal: Clin Neuroradiol Date: 2021-01-04 Impact factor: 3.649
Authors: J Scott McNally; Seong-Eun Kim; Jason Mendes; J Rock Hadley; Akihiko Sakata; Adam H De Havenon; Gerald S Treiman; Dennis L Parker Journal: Magn Reson Insights Date: 2017-03-07