title: Cost-effectiveness of magnetic resonance angiography versus intra-arterial digital subtraction angiography to follow-up patients with coiled intracranial aneurysms.
abstract: OBJECTIVE
  To follow up patients with coiled intracranial aneurysms, magnetic resonance angiography (MRA) is a promising noninvasive alternative to current standard intra-arterial digital subtraction angiography (IA-DSA). MRA test results do not always concord with those of IA-DSA, and the impact of discrepancies on health benefits and costs is unknown. We evaluated the cost-effectiveness of follow-up with MRA vs IA-DSA to assess whether in this setting MRA may replace IA-DSA.
  
  
  METHODS
  We studied aneurysm occlusion on MRA in addition to follow-up IA-DSA in 310 patients with 341 coiled intracranial aneurysms. The observed sensitivity (82%) and specificity (89%) of MRA for detection of reopening with IA-DSA as a reference were used as input for a Markov decision-analytic model. Other determinants were derived from the literature. We compared life expectancy, quality-adjusted life-years (QALY), costs, and expected number of events for the two strategies.
  
  
  RESULTS
  Follow-up with MRA yielded similar life expectancy (MRA, 26.66 years; IA-DSA, 26.63 years; difference, 0.03 years; 95% CI, -0.17-0.23) and QALY (MRA, 10.96; IA-DSA, 10.95; difference, 0.01 QALY; 95% CI, -0.05-0.08) at lower costs (MRA, $7003; IA-DSA, $8241 per patient; difference, -$1238; 95% CI, -2617--36). The expected number of events was comparable except for complications from IA-DSA.
  
  
  CONCLUSIONS
  MRA provided equivalent health benefits as IA-DSA and was cost-saving. MRA dominates and should replace routine IA-DSA to follow-up patients with coiled aneurysms.
authors.affiliation: Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands. j.d.schaafsma@umcutrecht.nl
authors.forename: Joanna D
authors.initials: JD
authors.lastname: Schaafsma
authors.forename: Hendrik
authors.initials: H
authors.lastname: Koffijberg
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
mesh_terms: D015901:Angiography, Digital Subtraction / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D003660:Decision Support Systems, Management / Q000191:economics; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000191:economics; D008017:Life Expectancy; D018810:Magnetic Resonance Angiography / Q000191:economics*; D008297:Male; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity