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.

Angiography, Digital Subtraction/*economics/methods, Contrast Media, Cost-Benefit Analysis, Costs and Cost Analysis, Decision Trees, Gadolinium, Humans, Intermittent Claudication/*economics/*radiography/therapy, Magnetic Resonance Angiography/economics, Quality-Adjusted Life Years, Research Support, Non-U.S. Gov't, Sensitivity and Specificity, Tomography, X-Ray Computed/*economics/methods
dx.doi.org/10.1148/radiol.2273020441, hdl.handle.net/1765/13162
Erasmus MC: University Medical Center Rotterdam

Visser, K, Kock, M.C.J.M, Kuntz, K.M, Donaldson, M.C, Gazelle, G.S, & Hunink, M.G.M. (2003). Cost-effectiveness targets for multi-detector row CT angiography in the work-up of patients with intermittent claudication. Radiology, 227(3), 647–656. doi:10.1148/radiol.2273020441