Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Neurosciences Department, Santa Maria Hospital/CHULN, University of Lisbon, Lisbon, Portugal.
Neuroradiology. 2019 Oct;61(10):1155-1163. doi: 10.1007/s00234-019-02252-7. Epub 2019 Jul 10.
Imaging is crucial for management of patients with possible cerebral venous thrombosis (CVT). To evaluate the cost-effectiveness of different noninvasive imaging strategies in patients with possible CVT.
A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALY) associated with the following imaging strategies: non-contrast CT (NCCT), NCCT plus CT venography (CTV), routine MRI without vascular imaging (R-MRI), and MRI with venography (MRV). The analysis was performed from a US healthcare perspective. Model input was based on best available and most recent evidence, including outcome data from the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Starting age was 37 years; both high and low pre-test probabilities of CVT were evaluated. Probabilistic sensitivity analyses (PSA) estimated model uncertainty.
In the base-case analysis, NCCT and CTV were dominant over R-MRI and MRV. CTV led to incremental lifetime QALYs compared with NCCT (23.385 QALYs vs. 23.374 QALYs) at slightly higher lifetime costs ($5210 vs. $5057). In PSA, CTV was the strategy with the highest percentage of cost-effective iterations if willingness-to-pay (WTP) thresholds were higher than $13,750/QALY. Complying with contemporary WTP thresholds, CTV was thus identified as the most cost-effective strategy. When the pre-test probability was set to 50%, CTV was also preferred.
In patients at the peak age of CVT incidence yet low clinical pre-test probability, diagnostic imaging with CTV is the most cost-effective strategy.
影像学检查对于疑似脑静脉血栓形成（CVT）患者的治疗至关重要。本研究旨在评估不同非侵入性影像学策略在疑似 CVT 患者中的成本效益。
基于马尔可夫模拟的决策模型估算了以下影像学策略相关的终生成本和质量调整生命年（QALY）：非对比 CT（NCCT）、NCCT 加 CT 静脉造影（CTV）、常规无血管成像 MRI（R-MRI）和 MRI 加静脉造影（MRV）。分析采用美国医疗保健视角。模型输入基于最佳且最新的证据，包括国际脑静脉和硬脑膜窦血栓形成研究（ISCVT）的结局数据。起始年龄为 37 岁；评估了 CVT 的高和低预测试概率。概率敏感性分析（PSA）估计了模型的不确定性。
在基准分析中，NCCT 和 CTV 优于 R-MRI 和 MRV。CTV 与 NCCT 相比，增加了终生 QALY（23.385 QALY 比 23.374 QALY），但终生成本略高（5210 美元比 5057 美元）。在 PSA 中，如果支付意愿（WTP）阈值高于 13750 美元/QALY，CTV 是最具成本效益的迭代策略比例最高的策略。符合当代 WTP 阈值，CTV 被确定为最具成本效益的策略。当预测试概率设置为 50%时，CTV 也是首选。
在 CVT 发病高峰年龄且临床预测试概率较低的患者中，CTV 诊断成像具有最高的成本效益。
