Costs in follow-up of endovascularly repaired abdominal aortic aneurysms. Magnetic resonance imaging with MR angiography versus EUROSTAR protocols.
OBJECTIVE
Endovascular repair of abdominal aortic aneurysms (AAA) necessitates a long-term follow-up. These patients are often old and renal insufficiency is not unusual. Cost-effectiveness needs to be addressed in evaluating methods of follow-up. The aim of this study was to compare costs of 5 years follow-up with magnetic resonance imaging with contrast enhanced three-dimensional magnetic resonance angiography (MRI/MRA) with follow-up using CT with DSA, or CTA. We also assessed the impact of contrast media induced (CMI) nephropathy on follow-up costs.


METHODS
We have implemented Swedish costs of CT with DSA, and CTA on the reported follow-up examinations from the EUROSTAR progress report 2000. The costs of follow-up with CT with DSA, or CTA were compared to a follow-up protocol with MRI/MRA. A cost analysis including a risk analysis of CMI nephropathy was made between MRI/MRA and CT with DSA, or CTA.


RESULTS
Excluding the risk of CMI nephropathy, the 5 years follow-up cost in Euro ( ) with MRI/MRA (  5715) is substantially higher than CT with DSA (  3 095) or CTA (  3573). The cost analysis favours MRI/MRA if the risk of CMI nephropathy from CT with DSA, or CTA is more than 5%.


CONCLUSIONS
MRI/MRA can be cost-effective for follow-up of endovascularly repaired AAA depending on the risk of CMI nephropathy for CT with DSA, and CTA. MRI/MRA should be the method of choice for patients with pre-existing renal insufficiency.
Engellau
L
L
Department of Radiology, Lund University Hospital, Lund, Sweden. lena.engellau@drad.lu.se
Albrechtsson
U
U
Höjgård
S
S
Norgren
L
L
Larsson
E-M
EM
D000368:Aged; D015901:Angiography, Digital Subtraction / Q000191:economics*; D017544:Aortic Aneurysm, Abdominal / Q000191:economics* / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D003287:Contrast Media / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000191:economics*; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D051437:Renal Insufficiency / Q000139:chemically induced / Q000453:epidemiology; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics*
D003287:Contrast Media