Cost effectiveness of magnetic resonance carotid plaque Imaging for primary stroke prevention in Canada.

The British journal of radiology

PubMedID: 29076745

E L, I B, K T, K C, Ar M, Pn T. Cost effectiveness of magnetic resonance carotid plaque Imaging for primary stroke prevention in Canada. Br J Radiol. 2017;20170518.
OBJECTIVES
Magnetic resonance (MR) imaging of the carotid arteries provides important insight into plaque composition and vulnerability in addition to the traditional measure of stenosis. The purpose of this study was to evaluate the cost-effectiveness of MR imaging as a first-line modality to assess carotid disease and guide management for high-risk patients with < 50% stenosis.

METHODS
Using TreeAge Pro, a cost effectiveness simulation was conducted comparing two strategies: a) standard of care first-line carotid duplex ultrasound (DUS) with regular follow-up, versus b) first-line MR assessment of stenosis and intraplaque hemorrhage (MRIPH) in which patients with IPH received annual DUS surveillance and immediate carotid endarterectomy in case of plaque progression.

RESULTS
For patients aged 70 years old, using a first-line MRIPH strategy resulted in a 16.8% relative risk reduction in strokes compared to DUS (0.080 vs 0.097 strokes per patient per lifetime), and an increased QALY (12.23 vs 12.20) at an increased cost of $897.33 over a patient's lifetime ($5,784.53 vs $4,887.20 average total cost per patient per lifetime). The incremental cost-effectiveness ratio (ICER) was $29,744 per QALY. MRIPH remained cost-effective below a willingness-to-pay threshold of $50,000 for 91.8% of sensitivity analyses.

CONCLUSIONS
MRIPH was found to be a cost-effective first-line tool to identify asymptomatic patients at high risk for stroke requiring annual surveillance and prompt management. Advances in Knowledge: Using MR imaging as a fist-line method to detect the presence of IPH provides clinically useful and cost-effective information that allows for enhanced risk evaluation and primary stroke prevention.