The cost-utility of CT angiography and conventional angiography for people presenting with intracerebral hemorrhage.
OBJECTIVE
To determine the optimal imaging strategy for ICH incorporating CTA or DSA with and without a NCCT risk stratification algorithm.


METHODS
A Markov model included costs, outcomes, prevalence of a vascular lesion, and the sensitivity and specificity of a risk stratification algorithm from the literature. The four imaging strategies were: (a) CTA screening of the entire cohort; (b) CTA only in those where NCCT suggested a high or indeterminate likelihood of a lesion; (c) DSA screening of the entire cohort and (d) DSA only for those with a high or indeterminate suspicion of a lesion following NCCT. Branch d was the comparator.


RESULTS
Age of the cohort and the probability of an underlying lesion influenced the choice of optimal imaging strategy. With a low suspicion for a lesion (<12%), branch (a) was the optimal strategy for a willingness-to-pay of $100,000/QALY. Branch (a) remained the optimal strategy in younger people (<35 years) with a risk below 15%. If the probability of a lesion was >15%, branch (b) became preferred strategy. The probabilistic sensitivity analysis showed that branch (b) was the optimal choice 70-72% of the time over varying willingness-to-pay values.


CONCLUSIONS
CTA has a clear role in the evaluation of people presenting with ICH, though the choice of CTA everyone or CTA using risk stratification depends on age and likelihood of finding a lesion.
Department of medical Imaging, University of Toronto, Division of Neuroradiology Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Richard I
RI
Aviv
Department of Neurology, University of Rochester, Rochester, New York, United States of America.
Adam G
AG
Kelly
Department of Neurosurgery, University of Rochester, Rochester, New York, United States of America; Department of Imaging Sciences, University of Rochester, Rochester, New York, United States of America.
Babak S
BS
Jahromi
Department of Neurology, University of Rochester, Rochester, New York, United States of America; Department of Neurosurgery, University of Rochester, Rochester, New York, United States of America.
Curtis G
CG
Benesch
Department of Neurology, University of Rochester, Rochester, New York, United States of America; Department of Neurosurgery, University of Rochester, Rochester, New York, United States of America; Department of Imaging Sciences, University of Rochester, Rochester, New York, United States of America.
Kate C
KC
Young
D000328:Adult; D000792:Angiography / Q000191:economics*; D002533:Cerebral Angiography / Q000191:economics*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000191:economics; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity