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Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection
OBJECTIVES: To investigate the cost-effectiveness of supplemental short-protocol brain MRI after negative non-contrast CT for the detection of minor strokes in emergency patients with mild and unspecific neurological symptoms. METHODS: The economic evaluation was centered around a prospective single...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8794930/ https://www.ncbi.nlm.nih.gov/pubmed/34455484 http://dx.doi.org/10.1007/s00330-021-08222-z |
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author | Puhr-Westerheide, Daniel Froelich, Matthias F Solyanik, Olga Gresser, Eva Reidler, Paul Fabritius, Matthias P Klein, Matthias Dimitriadis, Konstantin Ricke, Jens Cyran, Clemens C Kunz, Wolfgang G Kazmierczak, Philipp M |
author_facet | Puhr-Westerheide, Daniel Froelich, Matthias F Solyanik, Olga Gresser, Eva Reidler, Paul Fabritius, Matthias P Klein, Matthias Dimitriadis, Konstantin Ricke, Jens Cyran, Clemens C Kunz, Wolfgang G Kazmierczak, Philipp M |
author_sort | Puhr-Westerheide, Daniel |
collection | PubMed |
description | OBJECTIVES: To investigate the cost-effectiveness of supplemental short-protocol brain MRI after negative non-contrast CT for the detection of minor strokes in emergency patients with mild and unspecific neurological symptoms. METHODS: The economic evaluation was centered around a prospective single-center diagnostic accuracy study validating the use of short-protocol brain MRI in the emergency setting. A decision-analytic Markov model distinguished the strategies “no additional imaging” and “additional short-protocol MRI” for evaluation. Minor stroke was assumed to be missed in the initial evaluation in 40% of patients without short-protocol MRI. Specialized post-stroke care with immediate secondary prophylaxis was assumed for patients with detected minor stroke. Utilities and quality-of-life measures were estimated as quality-adjusted life years (QALYs). Input parameters were obtained from the literature. The Markov model simulated a follow-up period of up to 30 years. Willingness to pay was set to $100,000 per QALY. Cost-effectiveness was calculated and deterministic and probabilistic sensitivity analysis was performed. RESULTS: Additional short-protocol MRI was the dominant strategy with overall costs of $26,304 (CT only: $27,109). Cumulative calculated effectiveness in the CT-only group was 14.25 QALYs (short-protocol MRI group: 14.31 QALYs). In the deterministic sensitivity analysis, additional short-protocol MRI remained the dominant strategy in all investigated ranges. Probabilistic sensitivity analysis results from the base case analysis were confirmed, and additional short-protocol MRI resulted in lower costs and higher effectiveness. CONCLUSION: Additional short-protocol MRI in emergency patients with mild and unspecific neurological symptoms enables timely secondary prophylaxis through detection of minor strokes, resulting in lower costs and higher cumulative QALYs. KEY POINTS: • Short-protocol brain MRI after negative head CT in selected emergency patients with mild and unspecific neurological symptoms allows for timely detection of minor strokes. • This strategy supports clinical decision-making with regard to immediate initiation of secondary prophylactic treatment, potentially preventing subsequent major strokes with associated high costs and reduced QALY. • According to the Markov model, additional short-protocol MRI remained the dominant strategy over wide variations of input parameters, even when assuming disproportionally high costs of the supplemental MRI scan. |
format | Online Article Text |
id | pubmed-8794930 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-87949302022-02-02 Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection Puhr-Westerheide, Daniel Froelich, Matthias F Solyanik, Olga Gresser, Eva Reidler, Paul Fabritius, Matthias P Klein, Matthias Dimitriadis, Konstantin Ricke, Jens Cyran, Clemens C Kunz, Wolfgang G Kazmierczak, Philipp M Eur Radiol Neuro OBJECTIVES: To investigate the cost-effectiveness of supplemental short-protocol brain MRI after negative non-contrast CT for the detection of minor strokes in emergency patients with mild and unspecific neurological symptoms. METHODS: The economic evaluation was centered around a prospective single-center diagnostic accuracy study validating the use of short-protocol brain MRI in the emergency setting. A decision-analytic Markov model distinguished the strategies “no additional imaging” and “additional short-protocol MRI” for evaluation. Minor stroke was assumed to be missed in the initial evaluation in 40% of patients without short-protocol MRI. Specialized post-stroke care with immediate secondary prophylaxis was assumed for patients with detected minor stroke. Utilities and quality-of-life measures were estimated as quality-adjusted life years (QALYs). Input parameters were obtained from the literature. The Markov model simulated a follow-up period of up to 30 years. Willingness to pay was set to $100,000 per QALY. Cost-effectiveness was calculated and deterministic and probabilistic sensitivity analysis was performed. RESULTS: Additional short-protocol MRI was the dominant strategy with overall costs of $26,304 (CT only: $27,109). Cumulative calculated effectiveness in the CT-only group was 14.25 QALYs (short-protocol MRI group: 14.31 QALYs). In the deterministic sensitivity analysis, additional short-protocol MRI remained the dominant strategy in all investigated ranges. Probabilistic sensitivity analysis results from the base case analysis were confirmed, and additional short-protocol MRI resulted in lower costs and higher effectiveness. CONCLUSION: Additional short-protocol MRI in emergency patients with mild and unspecific neurological symptoms enables timely secondary prophylaxis through detection of minor strokes, resulting in lower costs and higher cumulative QALYs. KEY POINTS: • Short-protocol brain MRI after negative head CT in selected emergency patients with mild and unspecific neurological symptoms allows for timely detection of minor strokes. • This strategy supports clinical decision-making with regard to immediate initiation of secondary prophylactic treatment, potentially preventing subsequent major strokes with associated high costs and reduced QALY. • According to the Markov model, additional short-protocol MRI remained the dominant strategy over wide variations of input parameters, even when assuming disproportionally high costs of the supplemental MRI scan. Springer Berlin Heidelberg 2021-08-28 2022 /pmc/articles/PMC8794930/ /pubmed/34455484 http://dx.doi.org/10.1007/s00330-021-08222-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Neuro Puhr-Westerheide, Daniel Froelich, Matthias F Solyanik, Olga Gresser, Eva Reidler, Paul Fabritius, Matthias P Klein, Matthias Dimitriadis, Konstantin Ricke, Jens Cyran, Clemens C Kunz, Wolfgang G Kazmierczak, Philipp M Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection |
title | Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection |
title_full | Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection |
title_fullStr | Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection |
title_full_unstemmed | Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection |
title_short | Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection |
title_sort | cost-effectiveness of short-protocol emergency brain mri after negative non-contrast ct for minor stroke detection |
topic | Neuro |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8794930/ https://www.ncbi.nlm.nih.gov/pubmed/34455484 http://dx.doi.org/10.1007/s00330-021-08222-z |
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