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Cost-Effectiveness of Magnetic Resonance Angiography Versus Intra-arterial Digital Subtraction Angiography to Follow-Up Patients With Coiled Intracranial Aneurysms

Schaafsma, J. D., Koffijberg, H., Buskens, E., Velthuis, B. K., van der Graaf, Y. & Rinkel, G. J. E., Aug-2010, In : Stroke. 41, 8, p. 1736-1742 7 p.

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  • Joanna D. Schaafsma
  • Hendrik Koffijberg
  • Erik Buskens
  • Birgitta K. Velthuis
  • Yolanda van der Graaf
  • Gabriel J. E. Rinkel

Background and Purpose-To follow up patients with coiled intracranial aneurysms, magnetic resonance angiography (MRA) is a promising noninvasive alternative to current standard intra-arterial digital subtraction angiography (IA-DSA). MRA test results do not always concord with those of IA-DSA, and the impact of discrepancies on health benefits and costs is unknown. We evaluated the cost-effectiveness of follow-up with MRA vs IA-DSA to assess whether in this setting MRA may replace IA-DSA.

Methods-We studied aneurysm occlusion on MRA in addition to follow-up IA-DSA in 310 patients with 341 coiled intracranial aneurysms. The observed sensitivity (82%) and specificity (89%) of MRA for detection of reopening with IA-DSA as a reference were used as input for a Markov decision-analytic model. Other determinants were derived from the literature. We compared life expectancy, quality-adjusted life-years (QALY), costs, and expected number of events for the two strategies.

Results-Follow-up with MRA yielded similar life expectancy (MRA, 26.66 years; IA-DSA, 26.63 years; difference, 0.03 years; 95% CI, -0.17-0.23) and QALY (MRA, 10.96; IA-DSA, 10.95; difference, 0.01 QALY; 95% CI, -0.05-0.08) at lower costs (MRA, $7003; IA-DSA, $8241 per patient; difference, -$ 1238; 95% CI, -2617- -36). The expected number of events was comparable except for complications from IA-DSA.

Conclusion-MRA provided equivalent health benefits as IA-DSA and was cost-saving. MRA dominates and should replace routine IA-DSA to follow-up patients with coiled aneurysms. (Stroke. 2010; 41: 1736-1742.)

Original languageEnglish
Pages (from-to)1736-1742
Number of pages7
JournalStroke
Volume41
Issue number8
Publication statusPublished - Aug-2010

    Keywords

  • cost-benefit analysis, digital subtraction angiography, intracranial aneurysm, magnetic resonance angiography, GUGLIELMI DETACHABLE COILS, CASE-FATALITY RATES, SUBARACHNOID HEMORRHAGE, ENDOVASCULAR TREATMENT, CEREBRAL ANEURYSMS, MR-ANGIOGRAPHY, EMBOLIZATION, EXPERIENCE, MORTALITY, RETREATMENT

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