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Cost-effectiveness Targets for Multi–Detector Row CT Angiography in the Work-up of Patients with Intermittent Claudication¹

¹ From the Program for the Assessment of Radiological Technology (ART Program), Dept of Epidemiology and Biostatistics, and Dept of Radiology, Erasmus MC, University Med Center Rotterdam, Dr Molewaterplein 50, Rm Ee21-40B, 3015GE Rotterdam, the Netherlands (K.V., M.C.J.M.K., M.G.M.H.); Dept of Health Policy and Management, Harvard School of Public Health, Boston, Mass (K.M.K., G.S.G., M.G.M.H.); Division of Vascular Surgery, Brigham and Women’s Hosp, Boston, Mass (M.C.D.); and Decision Analysis and Technology Assessment Group, Dept of Radiology, Massachusetts General Hosp, Harvard Med School, Boston, Mass (G.S.G.). From the 2001 RSNA scientific assembly. Received Apr 15, 2002; revision requested Jun 19; revision received Jul 26; accepted Sep 23. Supported in part by the Netherlands Organization for Scientific Research. Address correspondence to K.V. (e-mail: k.visser@erasmusmc.nl).

PURPOSE: To determine the costs, sensitivity for detection of significant stenoses, and proportion of equivocal multi–detector row computed tomographic (CT) angiography results in the work-up of patients with intermittent claudication that would make this imaging examination cost-effective compared with gadolinium-enhanced magnetic resonance (MR) angiography.

MATERIALS AND METHODS: A decision model was used to compare the societal cost-effectiveness of a new imaging modality with that of gadolinium-enhanced MR angiography. Main outcome measures were quality-adjusted life years (QALYs) and lifetime costs. By using threshold analysis of a given willingness to pay per QALY, target values for costs, sensitivity for detection of significant stenoses, and proportion of cases requiring additional work-up with intraarterial digital subtraction angiography owing to equivocal results of the new modality were determined. The base case evaluated was that of 60-year-old men with severe intermittent claudication and assumed an incremental cost-effectiveness threshold of $100,000 per QALY.

RESULTS: If treatment were limited to angioplasty, a new imaging modality would be cost-effective if the costs were $300 and the sensitivity was 85%, even if up to 35% of patients needed additional work-up. When both angioplasty and bypass surgery were considered as treatment options, a new imaging modality was cost-effective if the costs were $300, the sensitivity was higher than 94%, and 20% of patients required additional work-up.

CONCLUSION: Multi–detector row CT angiography, as compared with currently used imaging modalities such as MR angiography, has the potential to be cost-effective in the evaluation of patients with intermittent claudication.

© RSNA, 2003

Index terms: Arteries, stenosis or obstruction, 92.721 • Computed tomography (CT), angiography, 92.12916 • Cost-effectiveness • Radiology and radiologists, socioeconomic issues

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