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  • October 2008

    Cost-Effectiveness in CT Angiography Confirmation of Internal Carotid Artery Occlusions

    Amercan Society of Neuroimaging | Devin L. Brown et al.


    CT Angiography is Cost-Effective for Confirmation of Internal Carotid Artery Occlusions


    Devin L. Brown, MD, MS; Stuart N. Hoffman, DO; Teresa L. Jacobs, MD; Kirsten L. Gruis, MD, MS; Susan L. Johnson, MD, MS; Michael E. Chernew, PhD


    American Society of Neuroimaging, 2007


    A Markov decision-analytic model was constructed to estimate the cost-effectiveness of CTA compared with catheter angiography in a hypothetical cohort of symptomatic patients with a screening examination consistent with an ICA occlusion. Costs in 2004 dollars were estimated from Medicare reimbursement. Effectiveness was measured in quality-adjusted life years.

    The 2-year cost in the CTA scenario was $9,178, and for catheter angiography, $11,531, consistent with a $2,353 cost-savings per person for CTA. CTA resulted in accrual of 1.83 quality-adjusted life years while catheter angiography resulted in 1.82 quality-adjusted life years. CTA was less costly and marginally more effective than catheter angiography.

    In sensitivity analyses, when CTA sensitivity and specificity were allowed to vary across a plausible range, CTA remained cost-effective. After screening examination has suggested an ICA occlusion, confirmatory testing with CTA provides similar effectiveness to catheter angiography and is less costly.

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