| Content Provider |
World Health Organization (WHO)-Global Index Medicus |
| Author |
Ivanidze, J. Charalel, R. A. Shuryak, I. Brenner, D. Pandya, A. Kallas, O. N. Kesavabhotla, K. Segal, A. Z. Simon, M. S. Sanelli, P. C. |
| Description |
Author Affiliation: Ivanidze J ( From the Departments of Radiology (J.I., R.A.C., O.N.K., K.K., P.C.S.) jai9018@nyp.org.); Charalel RA ( From the Departments of Radiology (J.I., R.A.C., O.N.K., K.K., P.C.S.).); Shuryak I ( Department of Radiology (I.S., D.B.), NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York.); Brenner D ( Department of Radiology (I.S., D.B.), NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York.); Pandya A ( Department of Health Policy and Management (A.P.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts.); Kallas ON ( From the Departments of Radiology (J.I., R.A.C., O.N.K., K.K., P.C.S.).); Kesavabhotla K ( From the Departments of Radiology (J.I., R.A.C., O.N.K., K.K., P.C.S.).); Segal AZ ( Neurology (A.Z.S.).); Simon MS ( Internal Medicine and Public Health (M.S.S.), Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York.); Sanelli PC ( Department of Radiology (M.S.S., P.C.S.), Northwell Health, Manhasset, New York.) |
| Abstract |
BACKGROUND AND PURPOSE: CT angiography and perfusion imaging is an important prognostic tool in the management of patients with aneurysmal subarachnoid hemorrhage. The purpose of this study was to perform a cost-effectiveness analysis of advanced imaging in patients with SAH, incorporating the risks of radiation exposure from CT angiography and CT perfusion imaging. MATERIALS AND METHODS: The risks of radiation-induced brain cancer and cataracts were incorporated into our established decision model comparing the cost-effectiveness of CT angiography and CT perfusion imaging and transcranial Doppler sonography in SAH. Cancer risk was calculated by using National Cancer Institute methodology. The remaining input probabilities were based on literature data and a cohort at our institution. Outcomes were expected quality-adjusted life years gained, costs, and incremental cost-effectiveness ratios. One-way, 2-way, and probabilistic sensitivity analyses were performed. RESULTS: CT angiography and CT perfusion imaging were the dominant strategies, resulting in both better health outcomes and lower costs, even when incorporating brain cancer and cataract risks. Our results remained robust in 2-way sensitivity analyses varying the prolonged latency period up to 30 years, with either brain cancer risk up to 50 times higher than the upper 95% CI limit or the probability of cataracts from 0 to 1. Results were consistent for scenarios that considered either symptomatic or asymptomatic patients with SAH. Probabilistic sensitivity analysis confirmed our findings over a broad range of selected input parameters. CONCLUSIONS: While risks of radiation exposure represent an important consideration, CT angiography and CT perfusion imaging remained the preferred imaging compared with transcranial Doppler sonography in both asymptomatic and symptomatic patients with SAH, with improved health outcomes and lower health care costs, even when modeling a significantly higher risk and shorter latency period for both cataract and brain cancer than that currently known. |
| File Format |
HTM / HTML |
| ISSN |
01956108 |
| e-ISSN |
1936959X |
| Journal |
American Journal of Neuroradiology |
| Issue Number |
3 |
| Volume Number |
38 |
| Language |
English |
| Publisher |
American Journal of Neuroradiology |
| Publisher Date |
2017-03-01 |
| Publisher Place |
United States |
| Access Restriction |
Open |
| Subject Keyword |
Neuroradiology Radiology Neurology |
| Content Type |
Text |
| Resource Type |
Article |
| Subject |
Radiology, Nuclear Medicine and Imaging Neurology (clinical) |
