CT Angiography Cost-Effective Validating Internal Carotid Artery Occlusion

Led by Dr. Brown, a researcher team from the University of Michigan's (Ann Arbor, USA) Stroke Program constructed a decision-analytic model to determine the cost benefits of CTA compared with catheter angiography in a hypothetic cohort of patients initially presenting with an ICA. The use of CTA was considered economical, demonstrating an overall net savings of US$2,353 per patient ($9,178 vs. $11,531). Regarding effectiveness, CTA and catheter angiography produced similar levels of success, with CTA resulting in an additional 1.83 quality-adjusted life years, while catheter angiography accrued 1.82. Costs were estimated based on standard U.S. Medicare reimbursement statistics, while effectiveness was measured in quality-adjusted life years.

This unique study is the first cost-effectiveness analysis related to carotid disease that has considered CTA as a factor. Although catheter angiography has long been the standard reference point in differentiating between a complete occlusion and severe stenosis, it is expensive, and bears with it the risk of stroke.

"Given rising healthcare costs, cost-minimizing diagnostic strategies need to be explored,” wrote Dr. Brown. "This analysis suggests that CTA can be used as a less expensive alternative to [catheter angiography] for confirmation of a suspected ICA occlusion, without sacrificing patient outcome.”

The study's findings were published in the October 2008 Journal of Neuroimaging.

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