title: Clinical utility and cost-effectiveness of CT-angiography in the diagnosis of nontraumatic subarachnoid hemorrhage.
abstract: BACKGROUND
  CT-angiography gains an increasing role in the initial diagnosis of patients with nontraumatic subarachnoid hemorrhage (SAH). However, the implementation of CT-angiography does not always exclude the necessity of conventional angiography. Our objective was to determine the practical utility and cost-effectiveness of CT-angiography.
  
  
  METHODS
  All patients with nontraumatic subarachnoid hemorrhage admitted to our university hospital after implementation of CT-angiography between June 1, 2011 and June 30, 2012 were retrospectively analyzed in regard to factors of treatment flow, radiation exposure, harms of contrast medium loading, and diagnostic costs. A control group of the same size was assembled from previously admitted SAH patients, who did not undergo pretreatment CT-angiography. Furthermore, cost-effectiveness analysis was performed.
  
  
  RESULTS
  The final analysis consisted of 93 patients in each group. Of 93 patients with pretreatment CT-angiography, 74 had to undergo conventional angiography for diagnostic and/or therapeutic purposes. CT-angiography had significant impact on the reduction of collective effective radiation dose by 4.419 mSv per person (p = 0.0002) and was not associated with additional harms. Despite the significantly earlier detection of aneurysms with CT-angiography (p < 0.0001), there were no significant differences in the timing of aneurysm repair and duration of ICU and general hospital stay. There was an increase of diagnostic costs-the cost-effectiveness analysis showed, however, that benefits of CT-angiography in respect to radiation exposure and risk of conventional angiography-related complications justify the additional costs of CT-angiography.
  
  
  CONCLUSIONS
  Although the implementation of CT-angiography in SAH diagnosis cannot completely replace conventional angiography, it can be approved in regard to radiation hygiene and cost-effectiveness.
authors: Department of Neurosurgery, University Hospital of Freiburg, Breisacher Straße 64, D-79106, Freiburg/Breisgau, Germany, radjapost@hotmail.com.
authors: Ramazan
authors: R
authors: Jabbarli
authors: Mukesch
authors: M
authors: Shah
authors: Christian
authors: C
authors: Taschner
authors: Klaus
authors: K
authors: Kaier
authors: Beate
authors: B
authors: Hippchen
authors: Vera
authors: V
authors: Van Velthoven
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000191:economics*; D003287:Contrast Media; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D019057:Quality-Adjusted Life Years; D011829:Radiation Dosage; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000191:economics*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol