Multicenter randomized controlled trial of the costs and effects of noninvasive diagnostic imaging in patients with peripheral arterial disease: the DIPAD trial.
OBJECTIVE
The purpose of our study was to compare the costs and effects of three noninvasive imaging tests as the initial imaging test in the diagnostic workup of patients with peripheral arterial disease.


METHODS
Of 984 patients assessed for eligibility, 514 patients with peripheral arterial disease were randomized to MR angiography (MRA) or duplex sonography in three hospitals and to MRA or CT angiography (CTA) in one hospital. The outcome measures included the clinical utility, functional patient outcomes, quality of life, and actual diagnostic and therapeutic costs related to the initial imaging test during 6 months of follow-up.


RESULTS
With adjustment for potentially predictive baseline variables, the learning curve, and hospital setting, a significantly higher confidence and less additional imaging were found for MRA and CTA compared with duplex sonography. No statistically significant differences were found in improvement in functional patient outcomes and quality of life among the groups. The total costs were significantly higher for MRA and duplex sonography than for CTA.


CONCLUSIONS
The results suggest that both CTA and MRA are clinically more useful than duplex sonography and that CTA leads to cost savings compared with both MRA and duplex sonography in the initial imaging evaluation of peripheral arterial disease.
Ouwendijk
Rody
R
Department of Radiology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. r.ouwendijk@erasmusmc.nl
de Vries
Marianne
M
Stijnen
Theo
T
Pattynama
Peter M T
PM
van Sambeek
Marc R H M
MR
Buth
Jaap
J
Tielbeek
Alexander V
AV
van der Vliet
Daan A
DA
SchutzeKool
Leo J
LJ
Kitslaar
Peter J E H M
PJ
de Haan
Michiel W
MW
van Engelshoven
Jos M A
JM
Hunink
M G Myriam
MG
D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000191:economics; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000628:therapy; D011788:Quality of Life; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics