Show simple item record

dc.contributor.authorSidorov, Evgeny V.en_US
dc.contributor.authorFeng, Wuweien_US
dc.contributor.authorSelim, Magdyen_US
dc.date.accessioned2014-07-07T18:14:56Z
dc.date.issued2014en_US
dc.identifier.citationSidorov, Evgeny V., Wuwei Feng, and Magdy Selim. 2014. “Cost-Minimization Analysis of Computed Tomography versus Magnetic Resonance Imaging in the Evaluation of Patients with Transient Ischemic Attacks at a Large Academic Center.” Cerebrovascular Diseases Extra 4 (1): 69-76. doi:10.1159/000360521. http://dx.doi.org/10.1159/000360521.en
dc.identifier.issn1664-5456en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:12407010
dc.description.abstractBackground: The type of neuroimaging for the evaluation of transient ischemic attack (TIA) is debatable. Many patients undergo head computed tomography (CT) with or without CT angiogram (CTA) while being at the emergency department (ED) and later magnetic resonance imaging (MRI) with MR angiogram (MRA) during admission. We hypothesized that evaluation with only one imaging modality (CT/CTA or MRI/MRA) is sufficient to formulate a treatment plan. We looked for the most cost-effective way to evaluate TIA patients. Methods: We performed a retrospective chart review of 82 patients with TIA. All patients had completely resolved neurological deficit at the time of their evaluation in the ED. We divided the patients into two groups. In group 1, the evaluation included CT with CTA of the head and neck. In group 2, the evaluation included brain MRI with MRA or CTA of the head and neck. We compared these two groups for clinical characteristics and etiological evaluations of stroke/TIA. The outcomes were measured by the number of therapeutic adjustments for the prevention of another ischemic stroke/TIA at the time of discharge from the hospital and revascularization procedures. We counted the following as therapeutic adjustment: (1) antiplatelet therapy was started de novo; (2) anticoagulation was started; (3) arterial revascularization procedure was performed, and (4) one antiplatelet agent was substituted for another. We performed a cost-effectiveness analysis if the outcomes of the two groups were different and a cost-minimization analysis if there was no difference in the outcomes. All cost calculations were made based on Medicare CPT codes. Results: Group 1 included 23 patients and group 2 59 patients. The patients in both groups had similar demographic and clinical characteristics. There was no difference in other etiological evaluations in groups 1 and 2. All patients underwent head CT as the first tool of evaluation whether MRI was done later or not. Therapeutic adjustments and revascularization procedures did not differ between the two groups. All head CTs showed no acute changes. MRI showed small ischemic infarcts in 44% of the patients in group 2. The average per-patient cost of neuroimaging with CT/CTA was USD 1,460.00, with CT and MRI/MRA USD 1,569 and with CT/CTA and brain MRI USD 2,090.00 (p < 0.01). Conclusion: Either MRI/MRA or CT/CTA might be sufficient for the evaluation of patients with TIA or small asymptomatic strokes. If head CT at the ED is bypassed, a brain MRI with MRA of the head and neck would be the most informative tool at the lowest cost. Prospective studies with larger numbers of patients are needed for a better understanding of the safety and cost of imaging tools used for patients with TIA.en
dc.language.isoen_USen
dc.publisherS. Karger AGen
dc.relation.isversionofdoi:10.1159/000360521en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995378/pdf/en
dash.licenseLAAen_US
dc.subjectTransient ischemic attacken
dc.subjectStrokeen
dc.subjectCosten
dc.subjectEvaluationen
dc.subjectMagnetic resonance imagingen
dc.subjectComputed tomography
en
dc.titleCost-Minimization Analysis of Computed Tomography versus Magnetic Resonance Imaging in the Evaluation of Patients with Transient Ischemic Attacks at a Large Academic Centeren
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalCerebrovascular Diseases Extraen
dash.depositing.authorSelim, Magdyen_US
dc.date.available2014-07-07T18:14:56Z
dc.identifier.doi10.1159/000360521*
dash.contributor.affiliatedSelim, Magdy


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record