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Living Renal Donors: Optimizing the Imaging Strategy—Decision- and Cost-effectiveness Analysis¹

¹ From the Program for the Assessment of Radiological Technology (ART Program) and the Departments of Epidemiology and Biostatistics (Y.S.L., M.C.J.M.K., K.V., M.G.M.H.), Radiology (Y.S.L., M.C.J.M.K., K.V., M.G.M.H.), Surgery (J.N.M.I.), and Internal Medicine (W.W.), Erasmus MC Rotterdam, Rm EE21-40a, Dr Molewaterplein 50, 3015 GE Rotterdam, the Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass (M.G.M.H.). From the 2001 RSNA scientific assembly. Received November 26, 2001; revision requested February 7, 2002; revision received March 21; accepted May 13. Supported in part by the Foundation for Health Care Efficiency Research and by the Netherlands Organization for Scientific Research. Address correspondence to M.G.M.H. (e-mail: hunink@epib.fgg.eur.nl).

PURPOSE: To determine the most cost-effective strategy for preoperative imaging performed in potential living renal donors.

MATERIALS AND METHODS: In a decision-analytic model, the societal cost-effectiveness of digital subtraction angiography (DSA), gadolinium-enhanced magnetic resonance (MR) angiography, contrast material–enhanced spiral computed tomographic (CT) angiography, and combinations of these imaging techniques was evaluated. Outcome measures included lifetime cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. A base-case analysis was performed with a 40-year-old female donor and a 40-year-old female recipient.

RESULTS: For the donor, MR angiography (24.05 QALYs and $9,000) dominated all strategies except for MR angiography with CT angiography, which had an incremental ratio of $245,000 per QALY. For the recipient, DSA and DSA with MR angiography yielded similar results (10.46 QALYs and $179,000) and dominated all other strategies. When results for donor and recipient were combined, DSA dominated all other strategies (34.51 QALYs and $188,000). If DSA was associated with a 99% specificity or less for detection of renal disease, MR angiography with CT angiography was superior (34.47 QALYs and $190,000).

CONCLUSION: For preoperative imaging in a potential renal donor, DSA is the most cost-effective strategy if it has a specificity greater than 99% for detection of renal disease; otherwise, MR angiography with CT angiography is the most cost-effective strategy.

© RSNA, 2002

Index terms: Computed tomography (CT), comparative studies, 81.12115 • Cost-effectiveness • Digital subtraction angiography, comparative studies, 81.124 • Kidney, transplantation, 81.455 • Magnetic resonance (MR), comparative studies, 81.12142, 81.12143

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