Evidence map›Paper›PMID 29076745›Full record

ArticleThe British journal of radiology2018

Cost-effectiveness of magnetic resonance carotid plaque imaging for primary stroke prevention in Canada.

Eli Lechtman, Indranil Balki, Kiersten Thomas, Kevin Chen, Alan R Moody, Pascal N Tyrrell

Abstract read
In one paragraph

Article in The British journal of radiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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

1 citing paper in PubMed.

  1. 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

6 authors.

Eli Lechtman1 Department of Medical Imaging,University of Toronto , University of Toronto , Toronto, ON , Canada.
Indranil Balki1 Department of Medical Imaging,University of Toronto , University of Toronto , Toronto, ON , Canada.
Kiersten Thomas1 Department of Medical Imaging,University of Toronto , University of Toronto , Toronto, ON , Canada.
Kevin Chen1 Department of Medical Imaging,University of Toronto , University of Toronto , Toronto, ON , Canada.
Alan R Moody1 Department of Medical Imaging,University of Toronto , University of Toronto , Toronto, ON , Canada.
Pascal N Tyrrell1 Department of Medical Imaging,University of Toronto , University of Toronto , Toronto, ON , Canada.ORCID 0000-0003-2277-3824

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveMagnetic resonance of the carotid arteries provides important insight into plaque composition and vulnerability in addition to the traditional measure of stenosis. The purpose of this study was to evaluate the cost-effectiveness of MR imaging as a first-line modality to assess carotid disease and guide management for high-risk patients with <50% stenosis.

methodsUsing TreeAge Pro, a cost-effectiveness simulation was conducted comparing two strategies: (a) standard of care first-line carotid duplex ultrasound (DUS) with regular follow-up, vs (b) first-line MR assessment of stenosis and intraplaque haemorrhage (MRIPH) in which patients with IPH received annual DUS surveillance and immediate carotid endarterectomy in case of plaque progression.

resultsFor patients aged 70 years old, using a first-line MRIPH strategy resulted in a 16.8% relative risk reduction in strokes compared to DUS (0.080 vs 0.097 strokes per patient per lifetime), and an increased quality-adjusted-life years (12.23 vs 12.20) at an increased cost of $897.33 over a patient's lifetime ($5784.53 vs $4887.20 average total cost per patient per lifetime). The incremental cost-effectiveness ratio was $29,744 per quality-adjusted-life years. MRIPH remained cost-effective below a willingness-to-pay threshold of $50,000 for 91.8% of sensitivity analyses.

conclusionMRIPH was found to be a cost-effective first-line tool to identify asymptomatic patients at high risk for stroke requiring annual surveillance and prompt management. Advances in Knowledge: Using MR imaging as a fist-line method to detect the presence of IPH provides clinically useful and cost-effective information that allows for enhanced risk evaluation and primary stroke prevention.

Indexed as

AgedAged, 80 and overAsymptomatic DiseasesCanadaCarotid ArteriesCarotid StenosisCost-Benefit AnalysisFemaleHumansMagnetic Resonance AngiographyMaleMiddle AgedPlaque, AtheroscleroticPrimary PreventionQuality-Adjusted Life YearsStroke

Identifiers

PMID29076745
PMCPMC5966215

What OpenQuestion holds

Textmetadata
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.