title: Effects of Radiation Exposure on the Cost-Effectiveness of CT Angiography and Perfusion Imaging in Aneurysmal Subarachnoid Hemorrhage.
abstract: CT angiography and perfusion imaging is an important prognostic tool in the management of patients with aneurysmal subarachnoid hemorrhage. The purpose of this study was to perform a cost-effectiveness analysis of advanced imaging in patients with SAH, incorporating the risks of radiation exposure from CT angiography and CT perfusion imaging.
  
  
  
  The risks of radiation-induced brain cancer and cataracts were incorporated into our established decision model comparing the cost-effectiveness of CT angiography and CT perfusion imaging and transcranial Doppler sonography in SAH. Cancer risk was calculated by using National Cancer Institute methodology. The remaining input probabilities were based on literature data and a cohort at our institution. Outcomes were expected quality-adjusted life years gained, costs, and incremental cost-effectiveness ratios. One-way, 2-way, and probabilistic sensitivity analyses were performed.
  
  
  
  CT angiography and CT perfusion imaging were the dominant strategies, resulting in both better health outcomes and lower costs, even when incorporating brain cancer and cataract risks. Our results remained robust in 2-way sensitivity analyses varying the prolonged latency period up to 30 years, with either brain cancer risk up to 50 times higher than the upper 95% CI limit or the probability of cataracts from 0 to 1. Results were consistent for scenarios that considered either symptomatic or asymptomatic patients with SAH. Probabilistic sensitivity analysis confirmed our findings over a broad range of selected input parameters.
  
  
  
  While risks of radiation exposure represent an important consideration, CT angiography and CT perfusion imaging remained the preferred imaging compared with transcranial Doppler sonography in both asymptomatic and symptomatic patients with SAH, with improved health outcomes and lower health care costs, even when modeling a significantly higher risk and shorter latency period for both cataract and brain cancer than that currently known.
authors.affiliation: From the Departments of Radiology (J.I., R.A.C., O.N.K., K.K., P.C.S.) jai9018@nyp.org.
authors.forename: J
authors.identifier: 0000-0002-6470-5400
authors.initials: J
authors.lastname: Ivanidze
authors.affiliation: From the Departments of Radiology (J.I., R.A.C., O.N.K., K.K., P.C.S.).
authors.forename: R A
authors.identifier: 0000-0001-9841-3839
authors.initials: RA
authors.lastname: Charalel
authors.affiliation: Department of Radiology (I.S., D.B.), NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York.
authors.forename: I
authors.identifier: 0000-0001-9314-5708
authors.initials: I
authors.lastname: Shuryak
authors.affiliation: Department of Radiology (I.S., D.B.), NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York.
authors.forename: D
authors.identifier: 0000-0002-0926-1210
authors.initials: D
authors.lastname: Brenner
authors.affiliation: Department of Health Policy and Management (A.P.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: A
authors.identifier: 0000-0002-6130-2286
authors.initials: A
authors.lastname: Pandya
authors.affiliation: From the Departments of Radiology (J.I., R.A.C., O.N.K., K.K., P.C.S.).
authors.forename: O N
authors.identifier: 0000-0002-2622-7479
authors.initials: ON
authors.lastname: Kallas
authors.affiliation: From the Departments of Radiology (J.I., R.A.C., O.N.K., K.K., P.C.S.).
authors.forename: K
authors.identifier: 0000-0001-5895-6935
authors.initials: K
authors.lastname: Kesavabhotla
authors.affiliation: Neurology (A.Z.S.).
authors.forename: A Z
authors.identifier: 0000-0001-8703-9108
authors.initials: AZ
authors.lastname: Segal
authors.affiliation: Internal Medicine and Public Health (M.S.S.), Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York.|Department of Radiology (M.S.S., P.C.S.), Northwell Health, Manhasset, New York.
authors.forename: M S
authors.identifier: 0000-0003-3256-1681
authors.initials: MS
authors.lastname: Simon
authors.affiliation: From the Departments of Radiology (J.I., R.A.C., O.N.K., K.K., P.C.S.).|Department of Radiology (M.S.S., P.C.S.), Northwell Health, Manhasset, New York.
authors.forename: P C
authors.identifier: 0000-0002-9633-3699
authors.initials: PC
authors.lastname: Sanelli
mesh_terms: D001932:Brain Neoplasms / Q000453:epidemiology / Q000209:etiology; D002386:Cataract / Q000453:epidemiology / Q000209:etiology; D000072226:Computed Tomography Angiography / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D055420:Perfusion Imaging / Q000009:adverse effects / Q000191:economics*; D019057:Quality-Adjusted Life Years; D000069079:Radiation Exposure; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000191:economics*; D017585:Ultrasonography, Doppler, Transcranial