Cost effectiveness in the detection of renal artery stenosis.

Cost effectivenesses of four tests for diagnosing renal artery stenosis were examined. Sensitivity, specificity, cost per patient, and cost per stenosis found for a variety of diagnostic strategies using these tests were retrospectively evaluated using clinical data from 605 hypertensive patients. Cost effectiveness of a given strategy was found to depend on the sequence in which the tests were performed, but to be relatively independent of the exact cost of the tests. Auscultation for a systolic/diastolic abdominal bruit was the most cost-effective test for beginning a diagnostic strategy and showed a 99.6% specificity for stenosis. When the patient has a systolic bruit only or no bruit, plasma renin activity measurement should guide the clinician's choice of whether to test further with intravenous pyelography or renal arteriography. Diagnosis of renal artery stenosis using these tests is estimated to cost between $2,300 and $6,200 per stenosis found, depending on the prevalence of renal artery stenosis.