CTA is cost-effective for confirming internal carotid artery occlusion

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CT angiography (CTA) to be an effective, cost-saving alternative to standard catheter angiography for confirmation of internal carotid artery (ICA) occlusions, according to a recent study published in this month’s Journal of Neuroimaging.

Led by Devin L. Brown, MD, a research team from the University of Michigan’s Stroke Program constructed a decision-analytic model to determine the cost benefits of CTA compared with catheter angiography in a hypothetical cohort of patients initially presenting with an ICA.  

The use of CTA was deemed cost-saving, demonstrating an overall net savings of $2,353 per patient ($9,178 vs. $11,531).  Regarding effectiveness, CTA and catheter angiography produced similar levels of success, with CTA resulting in an additional 1.83 quality-adjusted life years, while catheter angiography accrued 1.82.  Costs were estimated based on standard Medicare reimbursement statistics, while effectiveness was measured in quality-adjusted life years.  

The study is the first cost-effectiveness analysis related to carotid disease that has considered CTA as a factor, Brown said. The researchers concluded that after screening examination has suggested an ICA occlusion, confirmatory testing with CTA provides similar effectiveness to catheter angiography and is less costly.  

“Given rising healthcare costs, cost-minimizing diagnostic strategies need to be explored,” wrote Brown. “This analysis suggests that CTA can be used as a less expensive alternative to [catheter angiography] for confirmation of a suspected ICA occlusion, without sacrificing patient outcome.”