Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection

Abstract

Objectives To investigate the cost-effectiveness of supplemental short-protocol brain MRI after negative non-contrast CT for the detection of minor strokes in emergency patients with mild and unspecific neurological symptoms. Methods The economic evaluation was centered around a prospective single-center diagnostic accuracy study validating the use of short-protocol brain MRI in the emergency setting. A decision-analytic Markov model distinguished the strategies “no additional imaging” and “additional short-protocol MRI” for evaluation. Minor stroke was assumed to be missed in the initial evaluation in 40% of patients without short-protocol MRI. Specialized post-stroke care with immediate secondary prophylaxis was assumed for patients with detected minor stroke. Utilities and quality-of-life measures were estimated as quality-adjusted life years (QALYs). Input parameters were obtained from the literature. The Markov model simulated a follow-up period of up to 30 years. Willingness to pay was set to $100,000 per QALY. Cost-effectiveness was calculated and deterministic and probabilistic sensitivity analysis was performed. Results Additional short-protocol MRI was the dominant strategy with overall costs of $26,304 (CT only: $27,109). Cumulative calculated effectiveness in the CT-only group was 14.25 QALYs (short-protocol MRI group: 14.31 QALYs). In the deterministic sensitivity analysis, additional short-protocol MRI remained the dominant strategy in all investigated ranges. Probabilistic sensitivity analysis results from the base case analysis were confirmed, and additional short-protocol MRI resulted in lower costs and higher effectiveness. Conclusion Additional short-protocol MRI in emergency patients with mild and unspecific neurological symptoms enables timely secondary prophylaxis through detection of minor strokes, resulting in lower costs and higher cumulative QALYs. Key Points • Short-protocol brain MRI after negative head CT in selected emergency patients with mild and unspecific neurological symptoms allows for timely detection of minor strokes. • This strategy supports clinical decision-making with regard to immediate initiation of secondary prophylactic treatment, potentially preventing subsequent major strokes with associated high costs and reduced QALY. • According to the Markov model, additional short-protocol MRI remained the dominant strategy over wide variations of input parameters, even when assuming disproportionally high costs of the supplemental MRI scan.

Clinical Diagnosis and Magnetic Resonance Imaging in Patients With Transient and Minor Neurological Symptoms: A Prospective Cohort Study

“…In this study, the 30 years costs of an MRI strategy for patients with normal CT were estimated to be $26 304 compared with costs of $27 109 with a CT-only strategy. 24 However, in a more extensive study, which modeled most of the care pathway, MRI was not cost-effective compared with any other imaging modality (with incremental costs of between £63 and £407). 19 …”

“…In this study, the 30 years costs of an MRI strategy for patients with normal CT were estimated to be $26 304 compared with costs of $27 109 with a CT-only strategy. 24 However, in a more extensive study, which modeled most of the care pathway, MRI was not cost-effective compared with any other imaging modality (with incremental costs of between £63 and £407). 19 Countries or regions where access to MRI is not constrained could implement a policy of MRI scanning for all patients with transient or minor neurological symptoms and use the results of MRI to determine subsequent treatment.…”

The correlation between medial pattern of intracranial arterial calcification and white matter hyperintensities

“…As a result, studies on the cost-effectiveness of brain MRI modality for patients with potential CSVD may be needed in the future. It has been reported that in patients with minor stroke, additional brain MRI scanning has been found to enable timely secondary prophylaxis, which results in lower costs and higher cumulative quality-adjusted life years 44 . In light of the heavy burden of CSVD-related functional disability and cognitive impairment, appropriate brain MRI scanning will most likely ensure early detection and timely interventions on CSVD, thereby reducing long-term expense and improving final outcomes.…”

Applying Machine Learning to Carotid Sonographic Features for Recurrent Stroke in Patients With Acute Stroke

“…Regarding the ABCD3 serial score, Kiyohara et al discovered that adding intracranial arterial stenosis could further improve the score's predictive value for recurrent stroke (22). Although computed tomography and MRI are sensitive and accurate neuroimaging tools, they are often expensive and dependent on practitioners' interpretation skills, and their utilization rates vary widely (23,24). Carotid Doppler sonography provides a low-cost, lowrisk, and highly portable alternative modality for evaluating the vessels of patients with acute stroke (25).…”