http://repub.eur.nl/res/aut/930/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/13162/ 2003-06-01T00:00:00Z PURPOSE: To determine the costs, sensitivity for detection of significant stenoses, and proportion of equivocal multi-detector row computed tomographic (CT) angiography results in the work-up of patients with intermittent claudication that would make this imaging examination cost-effective compared with gadolinium-enhanced magnetic resonance (MR) angiography. MATERIALS AND METHODS: A decision model was used to compare the societal cost-effectiveness of a new imaging modality with that of gadolinium-enhanced MR angiography. Main outcome measures were quality-adjusted life years (QALYs) and lifetime costs. By using threshold analysis of a given willingness to pay per QALY, target values for costs, sensitivity for detection of significant stenoses, and proportion of cases requiring additional work-up with intraarterial digital subtraction angiography owing to equivocal results of the new modality were determined. The base case evaluated was that of 60-year-old men with severe intermittent claudication and assumed an incremental cost-effectiveness threshold of 100,000 US dollars per QALY. RESULTS: If treatment were limited to angioplasty, a new imaging modality would be cost-effective if the costs were 300 US dollars and the sensitivity was 85%, even if up to 35% of patients needed additional work-up. When both angioplasty and bypass surgery were considered as treatment options, a new imaging modality was cost-effective if the costs were 300 US dollars, the sensitivity was higher than 94%, and 20% of patients required additional work-up. CONCLUSION: Multi-detector row CT angiography, as compared with currently used imaging modalities such as MR angiography, has the potential to be cost-effective in the evaluation of patients with intermittent claudication. http://repub.eur.nl/res/pub/10042/ 2003-01-01T00:00:00Z PURPOSE: To determine the most cost-effective strategy for preoperative imaging performed in potential living renal donors. MATERIALS AND METHODS: In a decision-analytic model, the societal cost-effectiveness of digital subtraction angiography (DSA), gadolinium-enhanced magnetic resonance (MR) angiography, contrast material-enhanced spiral computed tomographic (CT) angiography, and combinations of these imaging techniques was evaluated. Outcome measures included lifetime cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. A base-case analysis was performed with a 40-year-old female donor and a 40-year-old female recipient. RESULTS: For the donor, MR angiography (24.05 QALYs and 9,000 dollars) dominated all strategies except for MR angiography with CT angiography, which had an incremental ratio of 245,000 dollars per QALY. For the recipient, DSA and DSA with MR angiography yielded similar results (10.46 QALYs and 179,000 dollars) and dominated all other strategies. When results for donor and recipient were combined, DSA dominated all other strategies (34.51 QALYs and 188,000 dollars). If DSA was associated with a 99% specificity or less for detection of renal disease, MR angiography with CT angiography was superior (34.47 QALYs and 190,000 dollars). CONCLUSION: For preoperative imaging in a potential renal donor, DSA is the most cost-effective strategy if it has a specificity greater than 99% for detection of renal disease; otherwise, MR angiography with CT angiography is the most cost-effective strategy. http://repub.eur.nl/res/pub/23596/ 2001-12-12T00:00:00Z http://repub.eur.nl/res/pub/9402/ 2000-01-01T00:00:00Z PURPOSE: To summarize and compare the published data on gadolinium-enhanced magnetic resonance (MR) angiography and color-guided duplex ultrasonography (US) for the work-up for peripheral arterial disease. MATERIALS AND METHODS: Studies published between January 1984 and November 1998 were included if (a) gadolinium-enhanced MR angiography and/or color-guided duplex US were performed for evaluation of arterial stenoses and occlusions in the work-up for peripheral arterial disease of the lower extremities, (b) conventional angiography was the reference standard, and (c) absolute numbers of true-positive, false-negative, true-negative, and false-positive results were available or derivable. RESULTS: With a random effects model, pooled sensitivity for MR angiography (97.5% [95% CI: 95.7%, 99.3%]) was higher than that for duplex US (87.6% [95% CI: 84.4%, 90.8%]). Pooled specificities were similar: 96.2% (95% CI: 94.4%, 97.9%) for MR angiography and 94.7% (95% CI: 93.2%, 96.2%) for duplex US. Summary receiver operating characteristic analysis demonstrated better discriminatory power for MR angiography than for duplex US. Regression coefficients for MR angiography versus US were 1.67 (95% CI: -0.23, 3.56) with adjustment for covariates, 2.11 (95% CI: 0.12, 4.09) without such adjustment, and 1.73 (95% CI: 0.44, 3.02) with a random effects model. CONCLUSION: Gadolinium-enhanced MR angiography has better discriminatory power than does color-guided duplex US and is a highly sensitive and specific method, as compared with conventional angiography, for the work-up for peripheral arterial disease.