Magnetic resonance angiography in progressive renal failure : a technology assessment.
The objective of this study was to assess the cost-effectiveness of magnetic resonance angiography imaging for renal artery stenosis in people with progressive renal failure.
We created a simulation model to determine the incremental cost-effectiveness of MRA screening in PRF compared with the fallback strategy of not screening.
Costs, probabilities, and utilities were estimated from the literature and from institutional data.
A three-state Markov model was used to simulate the progression from PRF to end-stage renal disease and death.
In our baseline analysis, assuming a sensitivity of 0.85 and a specificity of 0.8 of MRA for RAS, we obtained an incremental cost-effectiveness of MRA screening compared with no screening of $2,214 per quality-adjusted life year saved, which is less than many commonly performed procedures.
Under our baseline assumptions, if the receiver-operating characteristic curve of MRA for RAS is better than the chance curve, then MRA screening would be cost-effective.
The analysis was most sensitive to assumptions about renal function after correction of RAS and prevalence of RAS, although the results show that MRA remains cost-effective for reasonable ranges of these assumptions.
The use of MRA in PRF would be a worthwhile investment of resources in comparison with many currently funded procedures.
The expense and morbidity associated with end-stage renal disease make any reasonable way of delaying or preventing the disease worth examining in detail.
Mots-clés Pascal : Appareil circulatoire pathologie, Artère pathologie, Vaisseau sanguin pathologie, Appareil urinaire pathologie, Rein pathologie, Diagnostic, Homme, Imagerie RMN, Angiographie, Insuffisance rénale, Sténose, Artère rénale, Coût
Mots-clés Pascal anglais : Cardiovascular disease, Arterial disease, Vascular disease, Urinary system disease, Renal disease, Diagnosis, Human, Nuclear magnetic resonance imaging, Angiography, Renal failure, Stenosis, Renal artery, Costs
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0457345
Code Inist : 002B24A05. Création : 01/03/1996.