Published in: PLOS One
Authors: Wenru Shang; Huajie Jin; Amisha Vastani; Asfand Baig Mirza; Benjamin Fisher; Neeraj Kalra; Ian Anderson; Ahilan Kailaya-Vasan
Year: 2023
Publication details: 18(7):e0289144
DOI: 10.1371/journal.pone.0289144
Publication type: Journal article
Topic: Subarachnoid haemorrhage, repeat CTA, aneurysm diagnosis, diagnostic imaging, cost-effectiveness

Simple summary

This paper examines repeat delayed CTA after spontaneous subarachnoid haemorrhage when initial imaging does not show an aneurysm. It is helpful for content about diagnostic clarity, follow-up imaging and the importance of not assuming the cause has been fully excluded too early.

Mr Kailaya-Vasan’s involvement

Mr Kailaya-Vasan, consultant neurosurgeon and neurovascular surgeon, is listed as a contributing author on this publication.

Published abstract

The following abstract is reproduced from the original publication and is provided for reference. It may include technical terminology intended for clinical or academic audiences.

Background: In patients with intracranial aneurysm presenting with spontaneous subarachnoid hemorrhage (SAH), 15% of them could be missed by the initial diagnostic imaging. Repeat delayed imaging can help to identify previously undetected aneurysms, however, the cost-effectiveness of this strategy remains uncertain. Objective The aim of this study is to assess the cost-effectiveness of repeat delayed imaging in patients with SAH who had a negative result during their initial imaging. Methods A Markov model was developed to estimate the lifetime costs and quality-adjusted life-year (QALY) for patients who received or not received repeat delayed imaging. The analyses were conducted from a healthcare perspective, with costs reported in UK pounds and expressed in 2020 values. Extensive sensitivity analyses were performed to assess the robustness of the results. Results The base case incremental cost-effectiveness ratio (ICER) of repeat delayed imaging is GBP9,314 per QALY compared to no-repeat delayed imaging. This ICER is below the National Institute for Health and Care Excellence (NICE) GBP20,000 per QALY willingness-to-pay threshold. At the NICE willingness-to-pay threshold of GBP20,000 per QALY, the probability that repeat delayed imaging is most cost-effective is 0.81. The results are sensitive to age, the utility of survived patients with a favorable outcome, the sensitivity of repeat delayed imaging, and the prevalence of aneurysm. Conclusions This study showed that, in the UK, it is cost-effective to provide repeat delayed imaging using computed tomographic angiography (CTA) for patients with SAH who had a negative result in their initial imaging.

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This publication page is provided for general information about Mr Kailaya-Vasan’s academic work. It is not medical advice and should not be used to guide individual diagnosis or treatment decisions. Patients should discuss their individual symptoms, diagnosis and treatment options with a specialist.