Cost-effectiveness of magnetic resonance angiography versus intra-arterial digital subtraction angiography to follow-up patients with coiled intracranial aneurysms

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

Research output: Contribution to journalArticleAcademicpeer-review

28 Citations (Scopus)

Abstract

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.

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

Keywords

  • Cost-benefit analysis
  • Digital subtraction angiography
  • Intracranial aneurysm
  • Magnetic resonance angiography

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