Limits...
Cost – Utility Analysis of Magnetic Resonance Imaging Management of Patients with Acute Ischemic Stroke in a Spanish Hospital

View Article: PubMed Central

ABSTRACT

Introduction: Stroke has a high rate of long-term disability and mortality and therefore has a significant economic impact. The objective of this study was to determine from a social perspective, the cost–utility of magnetic resonance imaging (MRI) compared to computed tomography (CT) as the first imaging test in acute ischemic stroke (AIS).

Methods: A cost–utility analysis of MRI compared to CT as the first imaging test in AIS was performed. Economic evaluation data were obtained from a prospective study of patients with AIS ≤12 h from onset in one Spanish hospital. The measure of effectiveness was quality-adjusted life-years (QALYs) calculated from utilities of the modified Rankin Scale. Both hospital and post-discharge expenses were included in the costs. The incremental cost-effectiveness ratio (ICER) was calculated and sensitivity analysis was carried out. The costs were expressed in Euros at the 2004 exchange rate.

Results: A total of 130 patients were analyzed. The first imaging test was CT in 87 patients and MRI in 43 patients. Baseline variables were similar in the two groups. The mean direct cost was €5830.63 for the CT group and €5692.95 for the MRI group (P = not significant). The ICER was €11,868.97/QALY. The results were sensitive when the indirect costs were included in the analysis.

Conclusion: Total direct costs and QALYs were lower in the MRI group; however, this difference was not statistically significant. MRI was shown to be a cost-effective strategy for the first imaging test in AIS in 22% of the iterations according to the efficiency threshold in Spain.

Electronic supplementary material: The online version of this article (doi:10.1007/s40120-015-0029-x) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

Acceptability curve of magnetic resonance imaging versus computed tomography in patients with acute ischemic stroke. QALY quality-adjusted life-year
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4470974&req=5

Fig2: Acceptability curve of magnetic resonance imaging versus computed tomography in patients with acute ischemic stroke. QALY quality-adjusted life-year

Mentions: Table 5 shows the results of the ICER analysis. The use of MRI was observed to be a less expensive alternative, but resulted in less QALY than CT for the diagnosis of AIS. In the one-way sensitivity analyses, the ICER increased with all variables included, except with the adjusted QALY (Table 6). In the ICER analysis performed with the bootstrap, the simulated cases mainly fall in quadrants III and IV (Fig. 1). This result is confirmed in the acceptability curve of cost-effectiveness, where it can be appreciated that 22% of the iterations of the MRI result in a cost per QALY of €30,000, regarded as the limit of efficiency in Spain (Fig. 2).Table 5


Cost – Utility Analysis of Magnetic Resonance Imaging Management of Patients with Acute Ischemic Stroke in a Spanish Hospital
Acceptability curve of magnetic resonance imaging versus computed tomography in patients with acute ischemic stroke. QALY quality-adjusted life-year
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4470974&req=5

Fig2: Acceptability curve of magnetic resonance imaging versus computed tomography in patients with acute ischemic stroke. QALY quality-adjusted life-year
Mentions: Table 5 shows the results of the ICER analysis. The use of MRI was observed to be a less expensive alternative, but resulted in less QALY than CT for the diagnosis of AIS. In the one-way sensitivity analyses, the ICER increased with all variables included, except with the adjusted QALY (Table 6). In the ICER analysis performed with the bootstrap, the simulated cases mainly fall in quadrants III and IV (Fig. 1). This result is confirmed in the acceptability curve of cost-effectiveness, where it can be appreciated that 22% of the iterations of the MRI result in a cost per QALY of €30,000, regarded as the limit of efficiency in Spain (Fig. 2).Table 5

View Article: PubMed Central

ABSTRACT

Introduction: Stroke has a high rate of long-term disability and mortality and therefore has a significant economic impact. The objective of this study was to determine from a social perspective, the cost–utility of magnetic resonance imaging (MRI) compared to computed tomography (CT) as the first imaging test in acute ischemic stroke (AIS).

Methods: A cost–utility analysis of MRI compared to CT as the first imaging test in AIS was performed. Economic evaluation data were obtained from a prospective study of patients with AIS ≤12 h from onset in one Spanish hospital. The measure of effectiveness was quality-adjusted life-years (QALYs) calculated from utilities of the modified Rankin Scale. Both hospital and post-discharge expenses were included in the costs. The incremental cost-effectiveness ratio (ICER) was calculated and sensitivity analysis was carried out. The costs were expressed in Euros at the 2004 exchange rate.

Results: A total of 130 patients were analyzed. The first imaging test was CT in 87 patients and MRI in 43 patients. Baseline variables were similar in the two groups. The mean direct cost was €5830.63 for the CT group and €5692.95 for the MRI group (P = not significant). The ICER was €11,868.97/QALY. The results were sensitive when the indirect costs were included in the analysis.

Conclusion: Total direct costs and QALYs were lower in the MRI group; however, this difference was not statistically significant. MRI was shown to be a cost-effective strategy for the first imaging test in AIS in 22% of the iterations according to the efficiency threshold in Spain.

Electronic supplementary material: The online version of this article (doi:10.1007/s40120-015-0029-x) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus