Cost‐Effectiveness of Advanced Neuroimaging for Transient and Minor Neurological Events in the Emergency Department
Background Accurate diagnosis of patients with transient or minor neurological events can be challenging. Recent studies suggest that advanced neuroimaging can improve diagnostic accuracy in low‐risk patients with transient or minor neurological symptoms, but a cost‐effective emergency department di...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.019001 |
| _version_ | 1811334101509079040 |
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| author | Ava L. Liberman Hui Zhang Sara K. Rostanski Natalie T. Cheng Charles C. Esenwa Neil Haranhalli Puneet Singh Daniel L. Labovitz Richard B. Lipton Shyam Prabhakaran |
| author_facet | Ava L. Liberman Hui Zhang Sara K. Rostanski Natalie T. Cheng Charles C. Esenwa Neil Haranhalli Puneet Singh Daniel L. Labovitz Richard B. Lipton Shyam Prabhakaran |
| author_sort | Ava L. Liberman |
| collection | DOAJ |
| description | Background Accurate diagnosis of patients with transient or minor neurological events can be challenging. Recent studies suggest that advanced neuroimaging can improve diagnostic accuracy in low‐risk patients with transient or minor neurological symptoms, but a cost‐effective emergency department diagnostic evaluation strategy remains uncertain. Methods and Results We constructed a decision‐analytic model to evaluate 2 diagnostic evaluation strategies for patients with low‐risk transient or minor neurological symptoms: (1) obtain advanced neuroimaging (magnetic resonance imaging brain and magnetic resonance angiography head and neck) on every patient or (2) current emergency department standard‐of‐care clinical evaluation with basic neuroimaging. Main probability variables were: proportion of patients with true ischemic events, strategy specificity and sensitivity, and recurrent stroke rate. Direct healthcare costs were included. We calculated incremental cost‐effectiveness ratios, conducted sensitivity analyses, and evaluated various diagnostic test parameters primarily using a 1‐year time horizon. Cost‐effectiveness standards would be met if the incremental cost‐effectiveness ratio was less than willingness to pay. We defined willingness to pay as $100 000 US dollars per quality‐adjusted life year. Our primary and sensitivity analyses found that the advanced neuroimaging strategy was more cost‐effective than emergency department standard of care. The incremental effectiveness of the advanced neuroimaging strategy was slightly less than the standard‐of‐care strategy, but the standard‐of‐care strategy was more costly. Potentially superior diagnostic approaches to the modeled advanced neuroimaging strategy would have to be >92% specific, >70% sensitive, and cost less than or equal to standard‐of‐care strategy’s cost. Conclusions Obtaining advanced neuroimaging on emergency department patient with low‐risk transient or minor neurological symptoms was the more cost‐effective strategy in our model. |
| first_indexed | 2024-04-13T17:02:46Z |
| format | Article |
| id | doaj.art-e98a97eea77743b88f80721e2cb3ec69 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:02:46Z |
| publishDate | 2021-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e98a97eea77743b88f80721e2cb3ec692022-12-22T02:38:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-06-01101210.1161/JAHA.120.019001Cost‐Effectiveness of Advanced Neuroimaging for Transient and Minor Neurological Events in the Emergency DepartmentAva L. Liberman0Hui Zhang1Sara K. Rostanski2Natalie T. Cheng3Charles C. Esenwa4Neil Haranhalli5Puneet Singh6Daniel L. Labovitz7Richard B. Lipton8Shyam Prabhakaran9Department of Neurology Albert Einstein College of MedicineMontefiore Medical Center Bronx NYThe Center for Health and the Social Sciences University of Chicago Chicago ILDepartment of Neurology New York University Grossman School of Medicine New York NYDepartment of Neurology Albert Einstein College of MedicineMontefiore Medical Center Bronx NYDepartment of Neurology Albert Einstein College of MedicineMontefiore Medical Center Bronx NYDepartment of Neurosurgery and Radiology Albert Einstein College of MedicineMontefiore Medical Center Bronx NYDepartment of Medicine Albert Einstein College of MedicineMontefiore Medical Center Bronx NYDepartment of Neurology Albert Einstein College of MedicineMontefiore Medical Center Bronx NYDepartment of Neurology Albert Einstein College of MedicineMontefiore Medical Center Bronx NYDepartment of Neurology University of Chicago School of Medicine Chicago ILBackground Accurate diagnosis of patients with transient or minor neurological events can be challenging. Recent studies suggest that advanced neuroimaging can improve diagnostic accuracy in low‐risk patients with transient or minor neurological symptoms, but a cost‐effective emergency department diagnostic evaluation strategy remains uncertain. Methods and Results We constructed a decision‐analytic model to evaluate 2 diagnostic evaluation strategies for patients with low‐risk transient or minor neurological symptoms: (1) obtain advanced neuroimaging (magnetic resonance imaging brain and magnetic resonance angiography head and neck) on every patient or (2) current emergency department standard‐of‐care clinical evaluation with basic neuroimaging. Main probability variables were: proportion of patients with true ischemic events, strategy specificity and sensitivity, and recurrent stroke rate. Direct healthcare costs were included. We calculated incremental cost‐effectiveness ratios, conducted sensitivity analyses, and evaluated various diagnostic test parameters primarily using a 1‐year time horizon. Cost‐effectiveness standards would be met if the incremental cost‐effectiveness ratio was less than willingness to pay. We defined willingness to pay as $100 000 US dollars per quality‐adjusted life year. Our primary and sensitivity analyses found that the advanced neuroimaging strategy was more cost‐effective than emergency department standard of care. The incremental effectiveness of the advanced neuroimaging strategy was slightly less than the standard‐of‐care strategy, but the standard‐of‐care strategy was more costly. Potentially superior diagnostic approaches to the modeled advanced neuroimaging strategy would have to be >92% specific, >70% sensitive, and cost less than or equal to standard‐of‐care strategy’s cost. Conclusions Obtaining advanced neuroimaging on emergency department patient with low‐risk transient or minor neurological symptoms was the more cost‐effective strategy in our model.https://www.ahajournals.org/doi/10.1161/JAHA.120.019001cost‐effectivenessdiagnosisemergency departmentischemic stroketransient ischemic attack |
| spellingShingle | Ava L. Liberman Hui Zhang Sara K. Rostanski Natalie T. Cheng Charles C. Esenwa Neil Haranhalli Puneet Singh Daniel L. Labovitz Richard B. Lipton Shyam Prabhakaran Cost‐Effectiveness of Advanced Neuroimaging for Transient and Minor Neurological Events in the Emergency Department Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cost‐effectiveness diagnosis emergency department ischemic stroke transient ischemic attack |
| title | Cost‐Effectiveness of Advanced Neuroimaging for Transient and Minor Neurological Events in the Emergency Department |
| title_full | Cost‐Effectiveness of Advanced Neuroimaging for Transient and Minor Neurological Events in the Emergency Department |
| title_fullStr | Cost‐Effectiveness of Advanced Neuroimaging for Transient and Minor Neurological Events in the Emergency Department |
| title_full_unstemmed | Cost‐Effectiveness of Advanced Neuroimaging for Transient and Minor Neurological Events in the Emergency Department |
| title_short | Cost‐Effectiveness of Advanced Neuroimaging for Transient and Minor Neurological Events in the Emergency Department |
| title_sort | cost effectiveness of advanced neuroimaging for transient and minor neurological events in the emergency department |
| topic | cost‐effectiveness diagnosis emergency department ischemic stroke transient ischemic attack |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.019001 |
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