### Abstract

Objective: To determine the optimal imaging strategy for ICH incorporating CTA or DSA with and without a NCCT risk stratification algorithm. Methods: A Markov model included costs, outcomes, prevalence of a vascular lesion, and the sensitivity and specificity of a risk stratification algorithm from the literature. The four imaging strategies were: (a) CTA screening of the entire cohort; (b) CTA only in those where NCCT suggested a high or indeterminate likelihood of a lesion; (c) DSA screening of the entire cohort and (d) DSA only for those with a high or indeterminate suspicion of a lesion following NCCT. Branch d was the comparator. Results: Age of the cohort and the probability of an underlying lesion influenced the choice of optimal imaging strategy. With a low suspicion for a lesion (<12%), branch (a) was the optimal strategy for a willingness-to-pay of $100,000/QALY. Branch (a) remained the optimal strategy in younger people (<35 years) with a risk below 15%. If the probability of a lesion was >15%, branch (b) became preferred strategy. The probabilistic sensitivity analysis showed that branch (b) was the optimal choice 70-72% of the time over varying willingness-to-pay values. Conclusions: CTA has a clear role in the evaluation of people presenting with ICH, though the choice of CTA everyone or CTA using risk stratification depends on age and likelihood of finding a lesion.

Original language | English (US) |
---|---|

Article number | e96496 |

Journal | PloS one |

Volume | 9 |

Issue number | 5 |

DOIs | |

State | Published - May 13 2014 |

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### ASJC Scopus subject areas

- Biochemistry, Genetics and Molecular Biology(all)
- Agricultural and Biological Sciences(all)
- General

### Cite this

*PloS one*,

*9*(5), [e96496]. https://doi.org/10.1371/journal.pone.0096496

}

*PloS one*, vol. 9, no. 5, e96496. https://doi.org/10.1371/journal.pone.0096496

**The cost-utility of CT angiography and conventional angiography for people presenting with intracerebral hemorrhage.** / Aviv, Richard I.; Kelly, Adam G.; Jahromi, Babak S.; Benesch, Curtis G.; Young, Kate C.

Research output: Contribution to journal › Article

TY - JOUR

T1 - The cost-utility of CT angiography and conventional angiography for people presenting with intracerebral hemorrhage

AU - Aviv, Richard I.

AU - Kelly, Adam G.

AU - Jahromi, Babak S.

AU - Benesch, Curtis G.

AU - Young, Kate C.

PY - 2014/5/13

Y1 - 2014/5/13

N2 - Objective: To determine the optimal imaging strategy for ICH incorporating CTA or DSA with and without a NCCT risk stratification algorithm. Methods: A Markov model included costs, outcomes, prevalence of a vascular lesion, and the sensitivity and specificity of a risk stratification algorithm from the literature. The four imaging strategies were: (a) CTA screening of the entire cohort; (b) CTA only in those where NCCT suggested a high or indeterminate likelihood of a lesion; (c) DSA screening of the entire cohort and (d) DSA only for those with a high or indeterminate suspicion of a lesion following NCCT. Branch d was the comparator. Results: Age of the cohort and the probability of an underlying lesion influenced the choice of optimal imaging strategy. With a low suspicion for a lesion (<12%), branch (a) was the optimal strategy for a willingness-to-pay of $100,000/QALY. Branch (a) remained the optimal strategy in younger people (<35 years) with a risk below 15%. If the probability of a lesion was >15%, branch (b) became preferred strategy. The probabilistic sensitivity analysis showed that branch (b) was the optimal choice 70-72% of the time over varying willingness-to-pay values. Conclusions: CTA has a clear role in the evaluation of people presenting with ICH, though the choice of CTA everyone or CTA using risk stratification depends on age and likelihood of finding a lesion.

AB - Objective: To determine the optimal imaging strategy for ICH incorporating CTA or DSA with and without a NCCT risk stratification algorithm. Methods: A Markov model included costs, outcomes, prevalence of a vascular lesion, and the sensitivity and specificity of a risk stratification algorithm from the literature. The four imaging strategies were: (a) CTA screening of the entire cohort; (b) CTA only in those where NCCT suggested a high or indeterminate likelihood of a lesion; (c) DSA screening of the entire cohort and (d) DSA only for those with a high or indeterminate suspicion of a lesion following NCCT. Branch d was the comparator. Results: Age of the cohort and the probability of an underlying lesion influenced the choice of optimal imaging strategy. With a low suspicion for a lesion (<12%), branch (a) was the optimal strategy for a willingness-to-pay of $100,000/QALY. Branch (a) remained the optimal strategy in younger people (<35 years) with a risk below 15%. If the probability of a lesion was >15%, branch (b) became preferred strategy. The probabilistic sensitivity analysis showed that branch (b) was the optimal choice 70-72% of the time over varying willingness-to-pay values. Conclusions: CTA has a clear role in the evaluation of people presenting with ICH, though the choice of CTA everyone or CTA using risk stratification depends on age and likelihood of finding a lesion.

UR - http://www.scopus.com/inward/record.url?scp=84901263684&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901263684&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0096496

DO - 10.1371/journal.pone.0096496

M3 - Article

C2 - 24824194

AN - SCOPUS:84901263684

VL - 9

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 5

M1 - e96496

ER -