title: An ounce of prevention is worth a pound of cure: a cost-effectiveness analysis of incidentally detected aneurysms in functional MRI research.
abstract: 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.
authors.affiliation: Collaboration for Outcome Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Sadatsafavi
authors.forename: Carlo
authors.initials: C
authors.lastname: Marra
authors.forename: David
authors.initials: D
authors.lastname: Li
authors.forename: Judy
authors.initials: J
authors.lastname: Illes
mesh_terms: 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