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Research ArticleBrain
Open Access

Cost-Effectiveness of CT Angiography and Perfusion Imaging for Delayed Cerebral Ischemia and Vasospasm in Aneurysmal Subarachnoid Hemorrhage

P.C. Sanelli, A. Pandya, A.Z. Segal, A. Gupta, S. Hurtado-Rua, J. Ivanidze, K. Kesavabhotla, D. Mir, A.I. Mushlin and M.G.M. Hunink
American Journal of Neuroradiology September 2014, 35 (9) 1714-1720; DOI: https://doi.org/10.3174/ajnr.A3947
P.C. Sanelli
aFrom the Departments of Radiology (P.C.S., A.G., J.I., K.K., D.M.)
bPublic Health (P.C.S., A.P., S.H.-R., A.I.M.)
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A. Pandya
bPublic Health (P.C.S., A.P., S.H.-R., A.I.M.)
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A.Z. Segal
cNeurology (A.Z.S.), Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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A. Gupta
aFrom the Departments of Radiology (P.C.S., A.G., J.I., K.K., D.M.)
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S. Hurtado-Rua
bPublic Health (P.C.S., A.P., S.H.-R., A.I.M.)
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J. Ivanidze
aFrom the Departments of Radiology (P.C.S., A.G., J.I., K.K., D.M.)
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K. Kesavabhotla
aFrom the Departments of Radiology (P.C.S., A.G., J.I., K.K., D.M.)
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D. Mir
aFrom the Departments of Radiology (P.C.S., A.G., J.I., K.K., D.M.)
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A.I. Mushlin
bPublic Health (P.C.S., A.P., S.H.-R., A.I.M.)
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M.G.M. Hunink
dDepartments of Radiology and Epidemiology (M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands.
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  • Fig 1.
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    Fig 1.

    Multivariable (2-way) sensitivity analysis graph demonstrating how the decision depends on the values of the probability of positive findings on a CTA and CTP examination in symptomatic patients (Sx) and the probability of symptoms in the SAH population across all ranges. The new strategy represents CTAP imaging, and the standard strategy represents TCD imaging.

  • Fig 2.
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    Fig 2.

    Probabilistic sensitivity analysis scatterplot (A) and cost-effectiveness acceptability curves (B) comparing the new strategy versus the standard strategy. The new strategy represents CTAP imaging and the standard strategy represents TCD imaging.

Tables

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  • Health benefits (QALYs) and costs for the base case scenario and subgroup analyses in symptomatic and asymptomatic patients

    Imaging StrategyQALYsCost
    Base case scenario:
        CTAP13.89$147,097
        TCD13.62$154,719
        Difference (CTAP-TCD)+0.27−$7,622
    Symptomatic subgroup:
        CTAP13.75$149,382
        TCD13.74$152,820
        Difference (CTAP-TCD)+0.01−$3,438
    Asymptomatic subgroup:
        CTAP13.99$145,228
        TCD13.51$156,272
        Difference (CTAP-TCD)+0.48−$11,044
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American Journal of Neuroradiology: 35 (9)
American Journal of Neuroradiology
Vol. 35, Issue 9
1 Sep 2014
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P.C. Sanelli, A. Pandya, A.Z. Segal, A. Gupta, S. Hurtado-Rua, J. Ivanidze, K. Kesavabhotla, D. Mir, A.I. Mushlin, M.G.M. Hunink
Cost-Effectiveness of CT Angiography and Perfusion Imaging for Delayed Cerebral Ischemia and Vasospasm in Aneurysmal Subarachnoid Hemorrhage
American Journal of Neuroradiology Sep 2014, 35 (9) 1714-1720; DOI: 10.3174/ajnr.A3947

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Cost-Effectiveness of CT Angiography and Perfusion Imaging for Delayed Cerebral Ischemia and Vasospasm in Aneurysmal Subarachnoid Hemorrhage
P.C. Sanelli, A. Pandya, A.Z. Segal, A. Gupta, S. Hurtado-Rua, J. Ivanidze, K. Kesavabhotla, D. Mir, A.I. Mushlin, M.G.M. Hunink
American Journal of Neuroradiology Sep 2014, 35 (9) 1714-1720; DOI: 10.3174/ajnr.A3947
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