Key result
First-line MRIPH imaging in 70-year-old asymptomatic patients with <50% carotid stenosis reduced lifetime strokes by 16.8% compared to ultrasound, with an ICER of $29,744 per QALY.
Why the study?
Does first-line MRIPH improve cost-effectiveness and reduce strokes compared to DUS in asymptomatic patients with <50% carotid stenosis?
Does first-line MRIPH improve cost-effectiveness and reduce strokes compared to DUS in asymptomatic patients with <50% carotid stenosis?
Answers are grounded in this paper and cite their sources.
Using MR imaging as a first-line method to detect intraplaque hemorrhage in asymptomatic patients with <50% carotid stenosis is a cost-effective strategy for primary stroke prevention.
OBJECTIVE: Magnetic resonance of the carotid arteries provides important insight into plaque composition and vulnerability in addition to the traditional measure of stenosis. The purpose of this study was to evaluate the cost-effectiveness of MR imaging as a first-line modality to assess carotid disease and guide management for high-risk patients with <50% stenosis. METHODS: Using TreeAge Pro, a cost-effectiveness simulation was conducted comparing two strategies: (a) standard of care first-line carotid duplex ultrasound (DUS) with regular follow-up, vs (b) first-line MR assessment of stenosis and intraplaque haemorrhage (MRIPH) in which patients with IPH received annual DUS surveillance and immediate carotid endarterectomy in case of plaque progression. RESULTS: For patients aged 70 years old, using a first-line MRIPH strategy resulted in a 16.8% relative risk reduction in strokes compared to DUS (0.080 vs 0.097 strokes per patient per lifetime), and an increased quality-adjusted-life years (12.23 vs 12.20) at an increased cost of $897.33 over a patient's lifetime ($5784.53 vs $4887.20 average total cost per patient per lifetime). The incremental cost-effectiveness ratio was $29,744 per quality-adjusted-life years. MRIPH remained cost-effective below a willingness-to-pay threshold of $50,000 for 91.8% of sensitivity analyses. CONCLUSION: MRIPH was found to be a cost-effective first-line tool to identify asymptomatic patients at high risk for stroke requiring annual surveillance and prompt management. Advances in Knowledge: Using MR imaging as a fist-line method to detect the presence of IPH provides clinically useful and cost-effective information that allows for enhanced risk evaluation and primary stroke prevention.
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Lechtman et al. (2017) studied Asymptomatic occult <50% carotid stenosis. Magnetic resonance imaging for intraplaque haemorrhage (MRIPH) vs. Duplex ultrasound (DUS) was evaluated on Lifetime strokes per patient (16.8% relative risk reduction). First-line MRIPH imaging in 70-year-old asymptomatic patients with <50% carotid stenosis reduced lifetime strokes by 16.8% compared to ultrasound, with an ICER of $29,744 per QALY.
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