title: Systematic review, critical appraisal, and analysis of the quality of economic evaluations in stroke imaging.
abstract: OBJECTIVE
  This study reviews the quality of economic evaluations of imaging after acute stroke and identifies areas for improvement.
  
  
  METHODS
  We performed full-text searches of electronic databases that included Medline, Econlit, the National Health Service Economic Evaluation Database, and the Tufts Cost Effectiveness Analysis Registry through July 2012. Search strategy terms included the following: stroke*; cost*; or cost-benefit analysis*; and imag*. Inclusion criteria were empirical studies published in any language that reported the results of economic evaluations of imaging interventions for patients with stroke symptoms. Study quality was assessed by a commonly used checklist (with a score range of 0% to 100%).
  
  
  RESULTS
  Of 568 unique potential articles identified, 5 were included in the review. Four of 5 articles were explicit in their analysis perspectives, which included healthcare system payers, hospitals, and stroke services. Two studies reported results during a 5-year time horizon, and 3 studies reported lifetime results. All included the modified Rankin Scale score as an outcome measure. The median quality score was 84.4% (range=71.9%-93.5%). Most studies did not consider the possibility that patients could not tolerate contrast media or could incur contrast-induced nephropathy. Three studies compared perfusion computed tomography with unenhanced computed tomography but assumed that outcomes guided by the results of perfusion computed tomography were equivalent to outcomes guided by the results of magnetic resonance imaging or noncontrast computed tomography.
  
  
  CONCLUSIONS
  Economic evaluations of imaging modalities after acute ischemic stroke were generally of high methodological quality. However, important radiology-specific clinical components were missing from all of these analyses.
authors: From the Institute of Health Policy, Management and Evaluation (K.R.B., N.P., M.K.K., M.D.K., A.L.), Departments of Medical Imaging (K.R.B., R.I.A., A.R.M.), Surgery, Division of Urology (N.P.), Institute of Medical Science (R.I.A., A.R.M.), Medicine (M.K.K., M.D.K., A.L.), and Toronto Health Economics and Technology Assessment Collaborative (M.D.K.), University of Toronto, Toronto, ON, Canada; Institute for Clinical and Evaluative Sciences, Toronto, ON, Canada (M.K.K.); and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (A.L.).
authors: Kirsteen R
authors: KR
authors: Burton
authors: Nathan
authors: N
authors: Perlis
authors: Richard I
authors: RI
authors: Aviv
authors: Alan R
authors: AR
authors: Moody
authors: Moira K
authors: MK
authors: Kapral
authors: Murray D
authors: MD
authors: Krahn
authors: Andreas
authors: A
authors: Laupacis
mesh_terms: D003287:Contrast Media; D003362:Cost-Benefit Analysis; D003625:Data Collection; D004469:Economics, Hospital; D006282:Health Personnel / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D018803:Models, Economic; D059906:Neuroimaging / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012107:Research Design; D020521:Stroke / Q000175:diagnosis* / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: cost–benefit analysis; radiology; stroke