Key result
MRI plaque imaging to guide carotid endarterectomy is cost-effective at ~$16,000 per QALY vs. medical therapy.
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Evaluates the cost-effectiveness of MR imaging for carotid artery stenosis treatment, suggesting better outcomes with imaging-based strategies.
PURPOSE: To evaluate the cost-effectiveness of a decision-making rule based on the magnetic resonance (MR) imaging assessment of intraplaque hemorrhage (IPH) in patients with asymptomatic carotid artery stenosis. MATERIALS AND METHODS: Two competing stroke prevention strategies were compared: (a) an intensive medical therapy-based management strategy versus (b) an imaging-based strategy in which the subset of patients with asymptomatic carotid artery stenosis with IPH on MR images would undergo immediate carotid endarterectomy in addition to ongoing intensive medical therapy. Patients in the medical therapy-only group could undergo carotid endarterectomy only with substantial carotid artery stenosis disease progression. Lifetime quality-adjusted life years (QALYs) and costs were modeled for patients with asymptomatic carotid artery stenosis with 70%-89% and 50%-69% carotid artery stenosis at presentation. Risks of stroke and complications from carotid endarterectomy, costs, and quality of life values were estimated from published sources. RESULTS: The medical therapy-based strategy had a lower life expectancy (12.65 years vs 12.95 years), lower lifetime QALYs (9.96 years vs 10.05 years), and lower lifetime costs ($13 699 vs $15 297) when compared with the MR imaging IPH-based strategy. The incremental cost-effectiveness ratio (ICER) for the MR imaging IPH strategy compared with the medical therapy-based strategy was $16 000 per QALY by using a base-case 70-year-old patient. When using starting patient ages of 60 and 80 years, the ICERs for the MR imaging IPH strategy were $3100 per QALY and $73 000 per QALY, respectively. The ICERs for the MR imaging IPH strategy were slightly higher at all ages for 50%-69% stenosis but remained below a willingness-to-pay threshold of $100 000 per QALY for starting ages of 60 and 70 years. CONCLUSION: MR imaging IPH can be used as a cost-effective tool to identify patients with asymptomatic carotid artery stenosis most likely to benefit from carotid endarterectomy.
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Gupta et al. (2015) studied Asymptomatic carotid artery stenosis. MR imaging-based strategy for intraplaque hemorrhage (IPH) guiding carotid endarterectomy vs. Intensive medical therapy-based management strategy was evaluated on Lifetime quality-adjusted life years (QALYs) (ICER $16,000 per QALY). An MR imaging-based strategy for intraplaque hemorrhage to guide carotid endarterectomy was cost-effective compared with medical therapy alone, with a base-case ICER of $16,000 per QALY.
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