Cost-effectiveness of digital subtraction angiography in the setting of computed tomographic angiography negative subarachnoid hemorrhage.

摘要: Background Recent studies have documented the high sensitivity of computed tomography angiography (CTA) in detecting a ruptured aneurysm presence acute subarachnoid hemorrhage (SAH). The practice digital subtraction (DSA) when CTA does not reveal an has thus been called into question. Objective We examined this dilemma from cost-effectiveness perspective by using current decision analysis techniques. Methods A tree was created with use TreeAge Pro Suite 2012; 1 arm, CTA-negative SAH followed up DSA; other patients were observed without further imaging. Based on literature review, costs and utilities assigned to each potential outcome. Base-case analyses performed determine strategy. Monte Carlo simulation then conducted sampling variable over plausible distribution evaluate robustness model. Results With negative predictive value 95.7% for CTA, observation found be most cost-effective strategy ($6737/Quality Adjusted Life Year [QALY] vs $8460/QALY) base-case analysis. One-way demonstrated that DSA became more option if fell below 93.72%. produced incremental ratio $83 083/QALY. At conventional willingness-to-pay threshold $50 000/QALY, 83.6% simulations. Conclusion perform depends strongly therefore must evaluated at center treating these types patients. Given reported literature, performing all may every institution.