An ounce of prevention is worth a pound of cure: a cost-effectiveness analysis of incidentally detected aneurysms in functional MRI research.
OBJECTIVE
Despite ongoing debate about best practices for managing incidentally detected findings in brain research studies using magnetic resonance imaging (MRI), this issue has not been investigated from a health economics viewpoint. We applied a decision-analytic approach to assess the benefit of various strategies for functional MRI (fMRI) studies using intracranial aneurysms (IA) as a model.


METHODS
A decision tree and Markov model were created to simulate the impact on the lifetime costs and quality-adjusted life-years (QALY) of four different strategies for review of scans for the presence of IA. To populate the decision model, we used current evidence from the literature and results from a survey of experts.


RESULTS
Review of the anatomical scans by a nonspecialist is not cost-effective in any of the subgroups of participants. Full clinical examination of women with a positive family history before enrollment in a study is cost-effective. Cost-effectiveness of reviewing scans obtained from women without a family history and men with a positive family history of IA depends on the willingness-to-pay (λ) for a QALY: at λ of $50,000/QALY, review of scans by a specialist is cost-effective, whereas at λ of $100,000/QALY, a full clinical workup is the best option. Compared with not reviewing any scans, a customized strategy for each subgroup of participants results in an incremental cost-effectiveness ratio of $12,503 for λ=$50,000/QALY and $32,767 for λ=$100,000/QALY.


CONCLUSIONS
Tailored strategies based on the characteristics of research participants and λ for one QALY are needed to address the problem of incidental findings in research fMRI studies.
Sadatsafavi
Mohsen
M
Collaboration for Outcome Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.
Marra
Carlo
C
Li
David
D
Illes
Judy
J
D035843:Biomedical Research / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D033162:Incidental Findings; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000191:economics*; D020300:Intracranial Hemorrhages / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D008390:Markov Chains; D019057:Quality-Adjusted Life Years