title: Living renal donors: optimizing the imaging strategy--decision- and cost-effectiveness analysis.
abstract: OBJECTIVE
  To determine the most cost-effective strategy for preoperative imaging performed in potential living renal donors.
  
  
  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 dollars) dominated all strategies except for MR angiography with CT angiography, which had an incremental ratio of 245,000 dollars per QALY. For the recipient, DSA and DSA with MR angiography yielded similar results (10.46 QALYs and 179,000 dollars) and dominated all other strategies. When results for donor and recipient were combined, DSA dominated all other strategies (34.51 QALYs and 188,000 dollars). 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 dollars).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Program for the Assessment of Radiological Technology (ART Program) and the Department of Epidemiology and Biostatistics, Erasmus MC Rotterdam, The Netherlands.
authors.forename: Ylian S
authors.initials: YS
authors.lastname: Liem
authors.forename: Marc C J M
authors.initials: MC
authors.lastname: Kock
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.forename: Karen
authors.initials: K
authors.lastname: Visser
authors.forename: M G Myriam
authors.initials: MG
authors.lastname: Hunink
mesh_terms: D015901:Angiography, Digital Subtraction / Q000191:economics; D003362:Cost-Benefit Analysis; D003657:Decision Making; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging*; D016030:Kidney Transplantation / Q000191:economics; D018810:Magnetic Resonance Angiography / Q000191:economics; D008962:Models, Theoretical; D012680:Sensitivity and Specificity; D014019:Tissue Donors; D014057:Tomography, X-Ray Computed / Q000191:economics