title: Cost-effectiveness targets for multi-detector row CT angiography in the work-up of patients with intermittent claudication.
abstract: OBJECTIVE
  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.
  
  
  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 US dollars per QALY.
  
  
  RESULTS
  If treatment were limited to angioplasty, a new imaging modality would be cost-effective if the costs were 300 US dollars 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 US dollars, the sensitivity was higher than 94%, and 20% of patients required additional work-up.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Program for the Assessment of Radiological Technology, Department of Epidemiology and Biostatistics, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 50, Rm Ee21-40B, 3015GE Rotterdam, The Netherlands. k.visser@erasmusmc.nl
authors.forename: Karen
authors.initials: K
authors.lastname: Visser
authors.forename: Marc C J M
authors.initials: MC
authors.lastname: Kock
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: Magruder C
authors.initials: MC
authors.lastname: Donaldson
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
authors.forename: M G Myriam
authors.initials: MG
authors.lastname: Hunink
mesh_terms: D015901:Angiography, Digital Subtraction / Q000191:economics* / Q000379:methods; D003287:Contrast Media; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003663:Decision Trees; D005682:Gadolinium; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging* / Q000191:economics* / Q000628:therapy; D018810:Magnetic Resonance Angiography / Q000191:economics; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000379:methods
chemical_list: D003287:Contrast Media; D005682:Gadolinium