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Open Access 01-02-2022 | Magnetic Resonance Imaging | Neuro

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

Authors: Daniel Puhr-Westerheide, Matthias F Froelich, Olga Solyanik, Eva Gresser, Paul Reidler, Matthias P Fabritius, Matthias Klein, Konstantin Dimitriadis, Jens Ricke, Clemens C Cyran, Wolfgang G Kunz, Philipp M Kazmierczak

Published in: European Radiology | Issue 2/2022

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.

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Title: Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection
Authors: Daniel Puhr-Westerheide
Matthias F Froelich
Olga Solyanik
Eva Gresser
Paul Reidler
Matthias P Fabritius
Matthias Klein
Konstantin Dimitriadis
Jens Ricke
Clemens C Cyran
Wolfgang G Kunz
Philipp M Kazmierczak
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Computed Tomography
Stroke
Cranial MRI
Computed Tomography
CT of the Head
Published in: European Radiology / Issue 2/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-021-08222-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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