Cost-Effectiveness of Quantitative Magnetic Resonance Angiography Screening and Submaximal Angioplasty for Symptomatic Vertebrobasilar Disease.
Cost-Effectiveness of Quantitative Magnetic Resonance Angiography Screening and Submaximal Angioplasty for Symptomatic Vertebrobasilar Disease.
复制标题
定量磁共振血管造影筛查和次最大血管成形术治疗症状性椎基底动脉疾病的成本效益。
DOI：
10.1161/strokeaha.118.022339
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发表时间：
2018
期刊：
影响因子：
8.3
通讯作者：
VERiTASStudyGroup
中科院分区：
文献类型：
--
作者：
Esfahani,DarianR;Pandey,Dilip;Du,Xinjian;Rose-Finnell,Linda;Charbel,FadyT;Derdeyn,ColinP;Amin-Hanjani,Sepideh;VERiTASStudyGroup
Background and PurposeThe VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) study demonstrated posterior circulation distal flow status, determined by quantitative magnetic resonance angiography, is a robust predictor of vertebrobasilar stroke risk in patients with symptomatic atherosclerotic vertebrobasilar disease. Flow-compromised high-risk patients may benefit from flow-restoring endovascular procedures, such as submaximal angioplasty. In this study, we examine the cost-effectiveness of quantitative magnetic resonance angiography screening to identify patients who may benefit from submaximal angioplasty to restore vertebrobasilar flow.MethodsA Markov model was created comparing a no screening strategy with standard medical management alone and a screening strategy involving quantitative magnetic resonance angiography imaging and submaximal angioplasty for treatable patients with low vertebrobasilar flow for a 30-year time horizon. Outcomes included quality-adjusted life years (QALY) and lifetime costs. Rates of stroke and death were obtained from VERiTAS data, and disability rates and costs were derived from VERiTAS and the literature. A sensitivity analysis was performed with periprocedural stroke rate from angioplasty the primary variable of interest.ResultsAt a 6% periprocedural stroke risk, the screening strategy saved an average of 0.364 QALYs per patient and a lifetime cost savings of 7312versusthenoscreeningstrategy.Amongpatientswithlowflowsuitableforintervention,thebenefitwassubstantiallyhigher,averaging1.485QALYssavedandlifetimecostsavingsof 21 294. Across the entire cohort, QALY savings were observed at the end of the first year and economic savings at year 6. The benefit of screening declined at higher periprocedural risk.ConclusionsQuantitative magnetic resonance angiography screening and submaximal angioplasty with 6% periprocedural risk in suitable patients are cost effective both in terms of QALY and lifetime costs for patients with symptomatic vertebrobasilar occlusive disease. With potential health and economic savings, a clinical trial examining the periprocedural risk of submaximal angioplasty is warranted.Clinical Trial RegistrationURL: http://www. clinicaltrials. gov. Unique identifier: NCT00590980.
