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Cost-Effectiveness of Carotid Plaque MR Imaging as a Stroke Risk Stratification Tool in Asymptomatic Carotid Artery Stenosis.

TitleCost-Effectiveness of Carotid Plaque MR Imaging as a Stroke Risk Stratification Tool in Asymptomatic Carotid Artery Stenosis.
Publication TypeJournal Article
Year of Publication2015
AuthorsGupta A, Mushlin AI, Kamel H, Navi BB, Pandya A
JournalRadiology
Volume277
Issue3
Pagination763-72
Date Published2015 Dec
ISSN1527-1315
KeywordsAged, Aged, 80 and over, Carotid Stenosis, Cost-Benefit Analysis, Decision Making, Disease Progression, Endarterectomy, Carotid, Humans, Life Expectancy, Magnetic Resonance Imaging, Middle Aged, Models, Theoretical, Quality of Life, Risk Assessment, Stroke
Abstract

PURPOSE: To evaluate the cost-effectiveness of a decision-making rule based on the magnetic resonance (MR) imaging assessment of intraplaque hemorrhage (IPH) in patients with asymptomatic carotid artery stenosis.

MATERIALS AND METHODS: Two competing stroke prevention strategies were compared: (a) an intensive medical therapy-based management strategy versus (b) an imaging-based strategy in which the subset of patients with asymptomatic carotid artery stenosis with IPH on MR images would undergo immediate carotid endarterectomy in addition to ongoing intensive medical therapy. Patients in the medical therapy-only group could undergo carotid endarterectomy only with substantial carotid artery stenosis disease progression. Lifetime quality-adjusted life years (QALYs) and costs were modeled for patients with asymptomatic carotid artery stenosis with 70%-89% and 50%-69% carotid artery stenosis at presentation. Risks of stroke and complications from carotid endarterectomy, costs, and quality of life values were estimated from published sources.

RESULTS: The medical therapy-based strategy had a lower life expectancy (12.65 years vs 12.95 years), lower lifetime QALYs (9.96 years vs 10.05 years), and lower lifetime costs ($13 699 vs $15 297) when compared with the MR imaging IPH-based strategy. The incremental cost-effectiveness ratio (ICER) for the MR imaging IPH strategy compared with the medical therapy-based strategy was $16 000 per QALY by using a base-case 70-year-old patient. When using starting patient ages of 60 and 80 years, the ICERs for the MR imaging IPH strategy were $3100 per QALY and $73 000 per QALY, respectively. The ICERs for the MR imaging IPH strategy were slightly higher at all ages for 50%-69% stenosis but remained below a willingness-to-pay threshold of $100 000 per QALY for starting ages of 60 and 70 years.

CONCLUSION: MR imaging IPH can be used as a cost-effective tool to identify patients with asymptomatic carotid artery stenosis most likely to benefit from carotid endarterectomy.

DOI10.1148/radiol.2015142843
Alternate JournalRadiology
PubMed ID26098459
PubMed Central IDPMC4672599
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
KL2 TR000458 / TR / NCATS NIH HHS / United States
UL1 TR000457 / TR / NCATS NIH HHS / United States
UL1 TR002384 / TR / NCATS NIH HHS / United States
Category: 
Faculty Publication