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

Richard I. Aviv, Adam G. Kelly, Babak S. Jahromi, Curtis G. Benesch, Kate C. Young

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 languageEnglish (US)
Article numbere96496
JournalPloS one
Volume9
Issue number5
DOIs
StatePublished - May 13 2014

Fingerprint

Angiography
Cerebral Hemorrhage
hemorrhage
image analysis
Imaging techniques
Costs and Cost Analysis
Screening
screening
Costs
willingness to pay
blood vessels
Sensitivity analysis
Blood Vessels
Sensitivity and Specificity
Computed Tomography Angiography
methodology

ASJC Scopus subject areas

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

Cite this

Aviv, Richard I. ; Kelly, Adam G. ; Jahromi, Babak S. ; Benesch, Curtis G. ; Young, Kate C. / The cost-utility of CT angiography and conventional angiography for people presenting with intracerebral hemorrhage. In: PloS one. 2014 ; Vol. 9, No. 5.
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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.

In: PloS one, Vol. 9, No. 5, e96496, 13.05.2014.

Research output: Contribution to journalArticle

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