| Summary: | Aim: Digital variance angiography (DVA) is a recently developed image processing method capable of
improving image quality compared with the traditionally used digital subtraction angiography (DSA),
among patients undergoing lower limb x-ray angiography. This study aims to explore the potential cost–
effectiveness of DVA from an English National Health Service perspective. Materials & methods: A two-part
economic model, consisting of a decision tree and a Markov model, was developed to consider the costs
and health outcomes associated with the use of DVA as part of current practice imaging, compared with
x-ray angiography using standard DSA. The model explored the impact of DVA on the development of
acute kidney injury (AKI), chronic kidney disease and radiation-induced cancer over a lifetime horizon.
Both deterministic and probabilistic analyses were performed to assess the cost per quality-adjusted lifeyear
(QALY). Results: Base-case results indicate that DVA results in cost savings of £309 per patient, with
QALYs also improving (+0.025) over a lifetime. As shown in sensitivity analysis, a key driver of model results
is the relative risk (RR) reduction of contrast-associated acute kidney injury associatedwith use of DVA. The
intervention also decreases the risk of carcinoma over a lifetime. Scenario analyses show that cost savings
range from £310 to £553, with QALY gains ranging from 0.048 to 0.109 per patient. Conclusion: The use
of DVA could result in a decrease in costs and an increase in QALYs over a lifetime, compared with existing
imaging practice. The potential for this technology to offer an economically viable alternative to existing
image processing methods, through a reduction in contrast media volume and radiation exposure, has
been demonstrated.
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