Evidence map›Paper›PMID 26022634›Full record

ArticleStroke2015

Different Imaging Strategies in Patients With Possible Basilar Artery Occlusion: Cost-Effectiveness Analysis.

Sebastian E Beyer, Myriam G Hunink, Florian Schöberl, Louisa von Baumgarten, Steffen E Petersen, Martin Dichgans, Hendrik Janssen, Birgit Ertl-Wagner, Maximilian F Reiser, Wieland H Sommer

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Stroke, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Basilar Artery Occlusion: Diagnosis and Acute Treatment.Current treatment options in neurology · 2019
    Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Sebastian E BeyerFrom the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.).
Myriam G HuninkFrom the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.).
Florian SchöberlFrom the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.).
Louisa von BaumgartenFrom the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.).
Steffen E PetersenFrom the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.).
Martin DichgansFrom the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.).
Hendrik JanssenFrom the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.).
Birgit Ertl-WagnerFrom the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.).
Maximilian F ReiserFrom the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.).
Wieland H SommerFrom the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.). Wieland.Sommer@med.uni-muenchen.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeThis study evaluated the cost-effectiveness of different noninvasive imaging strategies in patients with possible basilar artery occlusion.

methodsA Markov decision analytic model was used to evaluate long-term outcomes resulting from strategies using computed tomographic angiography (CTA), magnetic resonance imaging, nonenhanced CT, or duplex ultrasound with intravenous (IV) thrombolysis being administered after positive findings. The analysis was performed from the societal perspective based on US recommendations. Input parameters were derived from the literature. Costs were obtained from United States costing sources and published literature. Outcomes were lifetime costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net monetary benefits, with a willingness-to-pay threshold of $80,000 per QALY. The strategy with the highest net monetary benefit was considered the most cost-effective. Extensive deterministic and probabilistic sensitivity analyses were performed to explore the effect of varying parameter values.

resultsIn the reference case analysis, CTA dominated all other imaging strategies. CTA yielded 0.02 QALYs more than magnetic resonance imaging and 0.04 QALYs more than duplex ultrasound followed by CTA. At a willingness-to-pay threshold of $80,000 per QALY, CTA yielded the highest net monetary benefits. The probability that CTA is cost-effective was 96% at a willingness-to-pay threshold of $80,000/QALY. Sensitivity analyses showed that duplex ultrasound was cost-effective only for a prior probability of ≤0.02 and that these results were only minimally influenced by duplex ultrasound sensitivity and specificity. Nonenhanced CT and magnetic resonance imaging never became the most cost-effective strategy.

conclusionsOur results suggest that CTA in patients with possible basilar artery occlusion is cost-effective.

Indexed as

Cost-Benefit AnalysisAngiographyBasilar ArteryHumansMagnetic Resonance ImagingMaleMiddle AgedProspective StudiesRegistriesTomography, X-Ray ComputedUltrasonography, Doppler, DuplexVertebrobasilar Insufficiencycost-effectiveness analysiseconomicsstroke

Identifiers

PMID26022634
PMCPMC4476845

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.