Incorporating XXXX -centered outcomes in the analysis of cost-effectiveness: imaging strategies for renovascular hypertension.

@entity1 @entity64 @entity101 @entity2791 @entity583 @entity454
OBJECTIVE: Our aim was to assess the contribution of @entity1 -centered short-term disutilities and quality-of-life measures in the cost-effectiveness analysis of CT angiography, MR angiography, and conventional angiography in @entity1 with medication-resistant @entity101 . MATERIALS AND METHODS: A decision analytic model compared the life expectancy and incremental cost per life year using three initial diagnostic tests in a cohort of hypothetical individuals with medication-resistant @entity101 over a range of @entity2791 probabilities: CT angiography (sensitivity, 96%; specificity, 96%; cost,  865); MR angiography (98%, 94%,  850); and conventional angiography (99%, 99%,  2,627). All imaging strategies were compared with a base case scenario mimicking the natural history of medication-resistant @entity101 and with a scenario immediate enhanced medical therapy without prior imaging. Individuals without evidence of @entity2791 on initial testing underwent conventional angiography if enhanced medical therapy failed to control @entity101 . Individuals diagnosed with @entity2791 on MR angiography required conventional angiography for definitive stent treatment ( 11,1223). Blood pressure response to renal artery stenting or enhanced medical therapy varied according to blood pressure, as did the incidence of @entity583 and @entity64 resulting from @entity101 . @entity1 who progressed to @entity454 received dialysis ( 60,000 per year). Quality-of-life adjustments were made for @entity1 with @entity101 , @entity454 , @entity583 , and @entity64 . Short-term disutilities from undergoing an imaging test were included. The analysis accounted for direct costs derived from Medicare reimbursements and total costs derived from the literature. RESULTS: All imaging strategies were cost-effective compared with enhanced medical therapy alone or with natural history. When only direct costs were considered, MR angiography was the preferred strategy, with conventional angiography as a cost-effective alternative to MR angiography. When total costs were considered, conventional angiography dominated all other strategies. Adjusting for quality of life decreased the incremental cost-effectiveness ratios, making an already competitive strategy a more favorable alternative to the base case. Adjusting for test-related disutility did not significantly influence the cost-effectiveness of any of the imaging tests. Despite marked variation in the key clinical and cost variables, MR angiography remained the most cost-effective strategy. CONCLUSION: In the evaluation and treatment of medication-resistant @entity101 , strategies that included preliminary imaging saved more lives than did the immediate institution of enhanced medical therapy at a lesser cost.
